Obesity is a well-known risk factor for developing severe coronavirus disease 2019 (COVID-19). In this study, we sought to determine the relationship between obesity and poor outcomes in patients with COVID-19 patients at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. We conducted a single-centered descriptive study of adult COVID-19 patients hospitalized between March 1 and December 31, 2020, at KAUH. Patients were classified according to body mass index (BMI) as overweight (BMI 25-29.9 kg/m²) or obese (BMI ≥30 kg/m²). The main outcomes were admission to the intensive care unit (ICU), intubation, and death. Data were analyzed from 300 COVID-19 patients. Most study participants were overweight (61.8%), and 38.2% were obese. The most significant comorbidities were diabetes (46.8%) and hypertension (41.9%). Both hospital mortality (10.4% for obese; 3.8% for overweight, p = 0.021) and intubation rates (34.6% for obese; 22.7% for overweight, p = 0.004) were significantly higher among obese patients than overweight patients. There was no significant difference in terms of ICU admission rate between both groups. However, intubation rates (34.6% for obese; 22.7% for overweight, p = 0.004) and hospital mortality (10.4% for obese; 3.8% for overweight, p = 0.021) were significantly higher among obese patients than overweight patients. This study aimed to describe the effect of high BMI on the clinical outcome of COVID-19 patients in Saudi Arabia. Obesity is significantly correlated with poor clinical outcomes in COVID-19. It is also associated with higher mortality and the need for mechanical ventilation necessitating intensive care unit admission. Patients with higher BMI should be prioritized in the hospital setting, as they have a higher potential of developing severe COVID-19 complications and sequelae.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition with significant economic burden, morbidity, and mortality rates worldwide. In the Kingdom of Saudi Arabia (KSA), 4.2% of adults 40 years and older have COPD, with a higher prevalence in men and older populations. Key risk factors include smoking, air pollution, occupational exposures, and genetics. COPD coexists with cardiovascular disease (CVD) often, making diagnosis and management more difficult. This study proposes two referral algorithms to optimize care for COPD patients with coexisting CVD in the KSA. Methods: A nine-member cardiopulmonary task force reviewed pertinent literature, guidelines, and held virtual meetings from April to August 2025. Every algorithmic component was iteratively refined; consensus was reached when at least 80% of participants agreed, and items not reaching this threshold were revised until full agreement was reached. Results: According to the cardiology-to-pulmonology algorithm, patients who have unidentified respiratory symptoms or COPD risk factors undergo spirometry assessment and, if confirmed, are referred to pulmonology for diagnostic confirmation, phenotyping, and treatment, including triple fixed-dose combination therapy (TFDC) when necessary. On the other hand, the pulmonology-to-cardiology algorithm directs the evaluation of CVD risk factors and comorbidities using clinical evaluation, electrocardiogram, echocardiography, and biomarker testing, for cardiology referral. Conclusions: By establishing bidirectional referral pathways, morbidity and healthcare burden can be decreased, early detection can be improved, and multidisciplinary management can be strengthened. Future research should assess the feasibility, cost-effectiveness, and real-world impact within KSA’s healthcare system.

Background: Filgotinib is an emerging Janus kinase 1 (JAK1) inhibitor being investigated for inflammatory bowel disease. This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of filgotinib in adult patients with moderate-to-severe crohn’s disease. Methods: We systematically searched PubMed, EMBASE, and Scopus through April 2025. Randomized controlled trials evaluating filgotinib versus placebo in adults with moderate-to-severe Crohn’s disease were included. Primary outcomes were clinical remission and endoscopic response. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool. A network meta-analysis was performed to integrate direct and indirect evidence, reporting risk ratios (RRs) with 95% confidence intervals (CIs). Results: Five randomized controlled trials (from 4 publications) met the inclusion criteria. Filgotinib 200 mg significantly improved clinical remission compared with placebo (RR: 1.75 [1.40–2.19]) and 100 mg (RR: 1.38 [1.11–1.71]), while 100 mg showed no significant difference versus placebo (RR: 1.27 [0.99–1.63]). For endoscopic response, both 200 mg (RR: 1.72 [1.09–2.69]) and 100 mg (RR: 1.65 [1.02–2.69]) demonstrated significant benefit over placebo, though no difference was observed between active doses (RR: 1.04 [0.64–1.68]; I² = 57%). In the two-item patient-reported outcome, 200 mg showed significant improvement versus placebo (RR: 1.47 [1.20–1.80]) and 100 mg (RR: 1.26 [1.02–1.55]), while 100 mg remained insignificant versus placebo (RR: 1.17 [0.93–1.46]). Neither dose increased the risk of treatment-emergent adverse events, serious adverse events, or infections compared with placebo, with consistent homogeneity across analyses. Conclusions: Filgotinib 200 mg demonstrated superior efficacy across clinical, endoscopic, and patient-reported outcomes compared with 100 mg and placebo, with a favorable safety profile. The 100 mg dose showed limited efficacy and no advantage over placebo. Filgotinib represents a promising oral therapeutic option, particularly for biologic-naïve patients and in maintenance therapy, while also showing potential benefit in perianal fistulising crohn’s disease. Future trials should explore long-term safety and head-to-head comparisons with established biologics.

Background: Transient Elastography FibroScan® and aspartate aminotransferase to platelets ratio index have frequently been evaluated in comparison to liver biopsy for the assessment of liver fibrosis. Methods: Cross-sectional study to correlate between Aspartate transaminase to platelets ratio index and liver Transient Elastography FibroScan® among patients with liver diseases. Aspartate transaminase to platelets ratio index (in IU/L) and platelet count (expressed as K/ul) were calculated. Transient Elastography FibroScan® scores were obtained and then the patients were categorized into four stages of fibrosis. Baseline characteristic data were obtained for each patient. IBM SPSS V.20 was used to perform a correlation analysis of stiff ness score and Aspartate transaminase to platelets ratio index. Moreover, one-way ANOVA was performed to test for differences in Aspartate transaminase to platelets ratio index, Platelets, and Aspartate Aminotransferase among different stages of fibrosis. Results: 235 patients were included: 141 (60%) males and 94 (40%) females. Th e most common cause of liver disease was chronic viral hepatitis C (38.3%). The majority of patients had mild fibrosis (F0-F1, n = 117 (49.8%)). Eighteen (7.6%) patients had F3, and 62 (26.4%) had cirrhosis (F4). Age > 40 years was associated with higher liver stiff ness compared with age ≤ 40 years. There was a profound relationship between stiffness score and Aspartate transaminase to platelets ratio index. Conclusion: Aspartate transaminase to platelets ratio index is strongly correlated with Transient Elastography FibroScan® in patients with advanced fibrosis and cirrhosis and can effectively categorize mild from advanced fibrosis or cirrhosis.

Purpose: Time to biologic initiation for the treatment of severe asthma (SA) is affected by many factors, including ease of access to biologics, which is often subject to approval by regulatory authorities and reimbursement criteria by relevant agencies. We investigated the association between ease of biologic access (using the biologic accessibility score [BACS] as a proxy) and post-biologic asthma outcomes, including remission. Methods: This ecological study, using data from CHRONICLE (a US severe asthma registry), the International Severe Asthma Registry (ISAR), and the Optimum Patient Care Research Database (OPCRD), included patients with SA from 21 countries. Associations at the country level, between BACS, a composite score of prescription criteria for biologics in SA, and the proportion of patients with a favorable asthma outcome 1-year post-biologic in each setting (ie ISAR country or in the CHRONICLE or OPCRD datasets) were tested. Several definitions of favorable outcome were used, including proportion of patients who achieved clinical remission (defined using 2, 3 and 4 domains), experienced no exacerbations, had well- or partly controlled asthma, a percent predicted forced expiratory volume in 1 second (ppFEV₁) or percent predicted peak expiratory flow rate (ppPEFR) ≥ 80%, and no long-term oral corticosteroid (LTOCS) use. Results: A total of 9,183 patients were included. A higher BACS (as a proxy of easier access to biologics) was associated with a higher likelihood of achieving clinical remission (p≤ 0.001), no exacerbations (p< 0.001), well- or partly controlled asthma (p=0.047), a ppFEV₁ or ppPEFR ≥ 80% (p=0.004), and no need for LTOCS (p=0.045) 1 year post-biologic initiation. Conclusion: Easier access to biologics for patients with SA, a prerequisite for shorter time-to-initiation, was associated with a greater probability of achieving clinical remission and other favorable asthma outcomes. Initiating biologics earlier in the asthma disease course may help unlock greater therapeutic potential in SA. These findings warrant confirmation in additional studies to further establish the causal relationship between biologic accessibility, timing of initiation, and clinical outcomes in SA.