Background and Aim: Thyroid cancer incidence has been increasing in Saudi Arabia, with variation by age and sex. This study aimed to evaluate the association of age and sex with clinicopathologic characteristics and outcomes of thyroid cancer.

Methods: We conducted a retrospective medical record review of adult patients with confirmed thyroid cancer diagnosed and/or treated at King Abdulaziz University Hospital, Jeddah, between January 2010 and December 2023. Demographic data, tumour characteristics, treatment, and outcomes were extracted. Statistical analyses were performed using SPSS version 26.

Results: Among 331 patients, papillary carcinoma was the most common histologic subtype. Older age at diagnosis was associated with more advanced stage, larger tumour size, and documented distant metastasis. Male patients were older at diagnosis and had larger tumours, and sex was associated with lymph node metastasis and invasion of adjacent structures.

Conclusion: In this single-center retrospective cohort, age and sex were associated with thyroid cancer characteristics and selected outcomes. These findings support considering age and sex when interpreting disease extent and planning follow-up, while recognizing the limitations of retrospective observational data.

Background: Restless Legs Syndrome (RLS) is a common but underdiagnosed neurological disorder that negatively affects sleep quality, mood, cardiovascular health, and quality of life. Aim: This systematic review and meta-analysis aimed to estimate the pooled prevalence of RLS among adults in Saudi Arabia and explore variation across population subgroups.

Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Ovid databases up to October 2025. Observational studies that reported RLS prevalence among adults (≥ 16 years) were considered. The pooled prevalence was calculated using a random-effects model (DerSimonian–Laird method), with heterogeneity assessed by the I² statistic and subgroup analyses conducted by population type and diagnostic criteria.

Results: Twenty studies with a total of 22,383 participants were included.The pooled prevalence of RLS in the general adult population of Saudi Arabia was 12.13% (95% CI, 8.13-16.79%) with high heterogeneity (I² = 98.3%). Subgroup analyses revealed markedly higher prevalence rates in specific clinical groups: 26% among patients with chronic conditions, 26% in pregnant women, and 18% among students. Studies using the International RLS Study Group criteria reported a pooled prevalence of 22%. Heterogeneity persisted within subgroups.

Conclusion: RLS is relatively common among adults in Saudi Arabia, particularly among highrisk and pregnant populations. These findings highlight the need for increased awareness, standardized screening, and further research to improve diagnosis and management of RLS across the Kingdom.

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome resulting from uncontrolled activation of cytotoxic T cells and macrophages. It often mimics sepsis, severe viral infections, or autoimmune hepatitis, leading to delayed diagnosis. While primary HLH arises from genetic defects in cytotoxic function and typically manifests in childhood, most adult cases are secondary, triggered by infection, malignancy, or autoimmune disease. Acute liver failure (ALF) as the predominant presentation of HLH is rare and diagnostically challenging, particularly when no clear trigger is identified.

Case summary: We describe a 24-year-old previously healthy Saudi woman with no significant past medical history, who presented with a monthlong history of fever, jaundice, dark urine, and right upper quadrant abdominal pain. Laboratory evaluation revealed acute fulminant liver failure with coagulopathy, bicytopenia (Hb 9.0 g/dL, platelets 54 × 10⁹/L), and extreme hyperferritinemia (>33,511 µg/L).Despite extensive evaluation, infectious, autoimmune, and metabolic causes were excluded. Her neurological status deteriorated, with EEG showing subclinical status epilepticus, requiring ICU admission and intubation. The H-Score was 259, indicating >99% probability of HLH, and bone marrow biopsy confirmed hemophagocytosis. She was treated with Emapalumab (anti–IFN-γ), intravenous immunoglobulin, and corticosteroids. Despite therapy, her condition progressed to multiorgan failure, and she died after 22 days of admission.

Conclusion: This case illustrates an unusual presentation of secondary HLH manifesting as acute liver failure, without an identifiable trigger. We highlight the importance of early consideration of HLH in adults with unexplained ALF and hyperferritinemia, as delayed diagnosis may preclude life-saving immunotherapy.