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Background Despite the success of childhood vaccination in reducing vaccine-preventable diseases (VPDs), vaccine hesitancy remains a significant challenge in several countries, such as Saudi Arabia, both during and beyond the COVID-19 era. Furthermore, the pandemic may have impacted vaccine hesitancy trends, potentially affecting parents' intentions to adhere to scheduled childhood vaccination programs. Aim This article aims to assess the extent of parents' hesitancy toward childhood vaccination, determine if it increased or decreased due to the COVID-19 pandemic, highlight the factors and determinants that influenced this hesitancy, whether positively or negatively, during the COVID-19 era, and estimate the acceptance of COVID-19 vaccination in relation to the acceptance of scheduled childhood vaccination. Methods A cross-sectional study was conducted in Saudi Arabia through a snowball sampling technique. Data were collected between September 2022 and October 2022 using an online survey using Google Forms. The inclusion criteria were parents or guardians in Saudi Arabia with a child up to 18 years of age. Responses were analyzed using SPSS V25 (IBM Corp., Armonk, NY, US), with chi-square tests and logistic regression performed to compare hesitancy and vaccination status. Results Among the 1,209 parents and care providers who participated, the prevalence of parents' vaccine hesitancy was 374 (30.9%). The educational level of the parents was not significantly associated with hesitancy status (p 0.490). The most refused vaccine was Mpox (345; 28.5%), whereas the one that caused the most hesitancy was the COVID-19 vaccine (352; 29.1%). Regarding the parents' concerns, the main reason for their hesitancy was the influence of their negative perceptions from social media content, including false or misleading information and negative allegations about vaccines, reported by 449 (18.98%) of the participants. Logistic regression analysis indicated that negative social media perceptions significantly increased the likelihood of vaccine hesitancy (OR = 2.15, 95% CI = 1.78-2.60, p < 0.001). Conclusion Our study highlights the prevalence of parental vaccine hesitancy during the COVID-19 era; the most significant hesitancy was observed toward the COVID-19 vaccine, and the mpox vaccine was the most rejected. Negative social media was the main reason for parental hesitancy; public health efforts should focus on providing accurate and easily accessible information through educational campaigns on social media and other platforms.

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Pediatric emergency visits with purpura fulminans should raise the suspicion of hereditary homozygous protein C deficiency even beyond the neonatal age. The absence of this classical finding does not role the diagnosis out as atypical presentation with isolated intraocular bleeding was observed. Premarital counseling should be offered when family history suggests.

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INTRODUCTION: Peters anomaly is a rare developmental malformation involving the anterior segment of the eye, which culminates in amblyopia or congenital blindness. Multiple ocular and/or systemic malformations have been observed with this anomaly, and novel comorbidities continue to be reported. CASE PRESENTATION: The probands were monozygotic twin boys (twin I and twin II) born to consanguineous parents at 36 weeks of gestation. Coarse facial features and deep-seated eyes were noted at birth. At 6 months, ophthalmic examination revealed that both twins were unable to blink in response to light, or to fixate and follow a moving object. Both twins had prominent horizontal nystagmus. Slit-lamp examination demonstrated varying degrees of central leukoma (corneal opacity) associated with iridocorneal adhesion, which is characteristic of type I Peters anomaly. No cataractous changes were observed. Normal intraocular pressure and disorganized retina were observed. Pupillary abnormalities included bilaterally underdeveloped pupils and bilateral absence of pupils was noted. Ocular MRI showed bilateral microphthalmia and optic nerve hypoplasia, with a small optic chiasm in both twins. At this age, the diagnosis of Peters anomaly was made. At 16 months of age, both twins developed deep venous thrombosis and purpuric skin lesions. Investigations revealed a hereditary thrombophilia secondary to a homozygous mutation causing protein C deficiency, which is a rare thrombotic condition. Ocular ultrasonography revealed bilateral vitreous hemorrhaging linked to altered coagulation. One twin developed bilateral inguinal hernia and cryptorchidism. CONCLUSION: The novel concordance of Peters anomaly in these monozygotic twins sharing a mutation in PROC gene provides further evidence that this anomaly has a genetic basis. Hypoplasia of the optic nerves and optic chiasm, along with severe protein C deficiency and bilateral absence of the pupils, are associated comorbidities that have not previously been reported with this anomaly.

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It has been widely assumed since the 1970s that right-handed writers, on average, do not write or simulate handwriting any better than left-handed writers. This study has dug deeper into that question, to find narrow language environments which left-handed and right-handed writers simulate with different degrees of success or making different types of errors. These might provide useful markers of handedness in writers or forgers. The sample of 823 native Arabic-writing adults, 763 right handed and 60 left handed, first attempted to simulate two Arabic signatures. As expected, the accuracy of the simulations of the two groups was not significantly different. Simulation accuracy of a variety of narrower elements was then measured to search for small environments in which the two groups performed differently. Two elements - slant and alignment - were significantly more poorly simulated by left-handed subjects than right-handed subjects, although the differences were not great enough to be useful in suggesting the handedness of a forger. These differences in simulation accuracy were not totally explored or explained. Instead, the differences in types of errors to slant and to alignment were investigated. Left-handed simulators, but not right-handed simulators, showed a strong tendency that had been predicted for both groups: to slant strokes and letters toward the side of the writing hand, when the target strokes and letters slanted in the opposite direction. The difference between the handedness groups was great enough that a strong preference for leftward slant in an Arabic writer or forger might suggest left handedness, but not, of course, rule out right handedness. Right-handed simulators, but not left-handed simulators, showed a strong tendency that had also been predicted for both groups: for the line of writing to be higher on the side where the writing hand was located. Again, the difference between handedness groups was great enough that a strong tendency for the writing line to fall to the left in Arabic writing and simulation might suggest right handedness, but would certainly not rule out left handedness. Thus, suggestive, but not absolute, markers of handedness have been found. In an effort to explain these almost mirror-image patterns, it was noticed that the operation of two more tendencies, in addition to the operation in both groups of the two predicted tendencies, might explain the patterns of the data. If we assume that both handedness groups tended to slant toward the writing hand and tended to make the writing line higher on the side of the writing hand, the two other tendencies operating in both groups would have been a tendency to slant strokes and letters toward the end of the writing line, and a tendency for writing to fall toward the end of the writing line. The operation of these four tendencies would account quite well for the right-handed and left-handed patterns in the two groups.

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This study investigates whether a writer's gender can be determined from an inspection of simulated signatures written in the Arabic alphabet or Arabic abjad. It is generally believed that the penmanship of female writers is superior to male writers. There is also reason to expect that superiority in writing skill might contribute to success in simulating the signatures of other writers. Simulated signatures produced by a large population of male (414) and female (312) Arabic writers were graded, and the results were statistically analyzed. Women were found to have a marginal advantage simulating all elements of the signatures, but there was no statistically significant difference between the genders on any of the elements examined.

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This article compares the skill with which a large sample of Arabic writers was able to simulate different handwriting elements in two Arabic signatures. The data agree with the consensus of experts about Roman script: Form is significantly better simulated than Proportion, and Proportion is significantly better simulated than Line Quality. The fact that patterns long observed in Roman script simulation can be statistically demonstrated to exist in the simulation of Arabic signatures suggests that these may be widespread, if not universal, patterns of simulation among writing systems. This is also supported by similar results from a study of abstract characters (Leung et al. 1993), which suggests that these tendencies may even transcend linguistic writing systems. Among the Proportional elements are slant, alignment, spacing, and size.

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