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Waleed Hakami,1 Gasim Dobie,1 Khadija A Alneami,1 Misk Shaabi,1 Khaled Essawi,1 Muhammad Saboor,2 Aymen M Madkhali,1 Mohammed H Nahari,3 Hassan H Almasoudi,3 Mohammad S Akhter,1 Fasial H Hakami,4 Fatimah A Zarbatan,5 Ali Hakamy,6 Rama M Chandika,7 Ali A Fageehi,1 Abdullah A Mobarki,1 Hassan A Hamali1 1Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; 3Department of Medical Laboratory Technology, Najran University, Najran, Saudi Arabia; 4Department of Epidemiology, College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia; 5Respiratory Care Department, King Fahad Central Hospital, Jazan, Ministry of Health, Jazan, Saudi Arabia; 6Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 7Department of Clinical Nutrition, College of Applied Medical Sciences, Jazan University, Jazan, Saudi ArabiaCorrespondence: Hassan A Hamali, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Gizan, 45142, Saudi Arabia, Email hhamali@jazanu.edu.saBackground: Nutritional anemia is a significant public health concern worldwide, particularly affecting young adults and children in Saudi Arabia, where inadequate nutrition is considered a primary contributing factor. This study aims to (i) examine the levels of serum iron, folate, and vitamin B12 in young adult students, with a focus on identifying any deficiencies and their association with anemia; (ii) explore the prevalence of mixed-deficiency anemia resulting from deficiencies in serum iron, folate, and vitamin B12 (iii) explore how sociodemographic characteristics and dietary habits influence serum iron, folate, and vitamin B12 levels.Materials and Methods: This cross-sectional study encompassed 158 young adult students at Jazan University, Saudi Arabia. Blood samples were collected following a comprehensive questionnaire addressing sociodemographic and health characteristics. These samples were analyzed for complete blood count, serum iron, folate, and vitamin B12 levels.Results: The findings of this study revealed a significant decrease in serum iron levels, with 70.6% of males and 88% in females exhibiting reduced level. Additionally, low levels of folate were observed in 4% of the study population, while deficiency in vitamin B12 was found in 2.2% of the study population. However, the simultaneous presence of low serum iron levels along with deficiencies in folate or vitamin B12 was not observed in the study participants.Conclusion: The study indicates that there is a high incidence of low serum iron and ferritin levels among university students in Saudi Arabia, which poses a considerable public health concern. Conversely, the prevalence of folate and vitamin B12 deficiencies among the students was comparatively low, and notably, there were no cases where these deficiencies were observed alongside iron deficiency.Keywords: anemia, folate, vitamin B12, serum iron, iron deficiency

Khaled Essawi,1 Gasim Dobie,1 Misk F Shaabi,1 Waleed Hakami,1 Muhammad Saboor,2 Aymen M Madkhali,1 Abdullah AH Hamami,3 Wael H Allallah,3 Mohammad S Akhter,1 Abdullah A Mobarki,1 Hassan A Hamali1 1Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates; 3Department of Laboratory & Blood Bank, Prince Mohammed bin Nasser Hospital, Ministry of Health, Jazan, Saudi ArabiaCorrespondence: Hassan A Hamali, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Gizan, 45142, Saudi Arabia, Email hhamali@jazanu.edu.saBackground: Diabetes mellitus (DM) is a major health burden affecting 537 million adults worldwide, characterized by chronic metabolic disorder and various complications. This case control study aimed to assess the impact of type 2 diabetes mellitus (T2DM), including hyperglycemia levels, on hematological parameters and complete blood count (CBC) derived parameters.Methods: A total of 250 known diabetic patients from the Jazan Diabetic Center, Saudi Arabia, between January 2021 and December 2022, along with 175 healthy adult controls were recruited from Jazan Hospital’s blood donation center. Demographic characteristics, medical histories, and relevant factors such as gender, age, BMI, treatment, disease duration, and comorbidities were collected with informed consent.Results: The results of the red blood cell (RBC) count, RBC indices, and mean platelet volume showed significant differences between patients and controls, while the white cell (WBC) and platelet count were comparable between the two groups. CBC-derived parameters, especially neutrophil/lymphocyte ratio (NLR), and platelet/neutrophil ratio (PNR) exhibited significant differences.Conclusion: CBC and derived parameters serve as inexpensive tools for T2DM patients monitoring, indicating early blood cell alterations and potential development of anemia. Further studies are needed to explore their role in predicting T2DM pathogenesis and progression, aiming to reduce severe complications, mortality and morbidity.Keywords: diabetes mellitus, complete blood count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet/neutrophil ratio, mean platelet volume/platelet count, disease complication

Mohamed Moukhyer,1,2 Mohamed Salih Mahfouz,3 Mahmoud M Habibullah,4 Nouf Hussain Abuhadi,5 Nizar A Khamjan,4 Aymen M Madkhali,4 Ali O Hakamy,6 Hassan A Hamali,4 Mazharul Hoque,1 Mohtashim Lohani,1 Aziza Mukhayer7,8 1Emergency Medical Services, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Public Health Programs, School of Medicine, University of Limerick, Limerick, Ireland; 3Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia; 4Medical Laboratory Technology Department, Jazan University, Jazan, Saudi Arabia; 5Diagnostic Radiology Technology Department, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 6Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 7Faculty of Medicine, Ahfad University for Women, Omdurman, Sudan; 8Department of Health Promotion, University of Maastricht, Maastricht, The NetherlandCorrespondence: Mohamed Moukhyer, Tel +966-568878291, Email mmoukhyer@jazanu.edu.saBackground: The emergence of COVID-19 posed a threat to millions of lives worldwide. The pandemic impacts extended to affect people’s psychological well-being, resulting in significant behavioural change. This study was designed to assess the knowledge regarding COVID-19 precautions among the College of Applied Medical Science students at Jazan University and to evaluate the general, psychosocial, and behavioral changes due to COVID-19.Methods: This is an observational study targeting 630 undergraduate students randomly selected during January 2020, using stratified random sampling. Data were collected using an online questionnaire. Linear regression models were used to evaluate the predictors of three outcome measures: knowledge, attitudes, and practice scores.Results: Knowledge of COVID-19 revealed that the students with correct answers ranged from 48.9 to 95%. Furthermore, significant gender differences are found regarding shortness of breath, fatigue, persistent chest discomfort, headache, and malaise (p < 0.05). Knowledge scores differed significantly across gender and academic level (p < 0.05) and so does attitude scores (p < 0.05). No significant difference was observed between practice scores according to socio-demographic background (p > 0.05). The linear regression model showed that females had significantly higher knowledge, attitudes, and practice scores (p < 0.05) as well as those within the 21– 23 age group and above (p < 0.05). Students residing in urban and semi-urban places had significantly higher scores for knowledge, attitudes, and practice (p < 0.05).Conclusion: The results demonstrated moderate knowledge about COVID-19 among study participants, with significant differences between the responses of males and females and among the urban and rural populations. Outcomes suggest the need for interventions to bridge students’ knowledge about COVID-19 and practice gaps. Students were concerned about basic life amenities and the inability to provide for their dear ones regarding behavioral changes.Keywords: COVID-19, health and safety, public health

Aymen M Madkhali,1 Abdullah A Mobarki,1 Ahmad H Ghzwani,2 Hesham M Al-Mekhlafi,2 Ahmed Zhranei,1 Abdulrahman Osais,1 Ahmed Sohel,1 Basim Othman,3 Gasim Dobie,1 Hassan A Hamali1 1Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 2Medical Research Center, Jazan University, Gizan, Saudi Arabia; 3Department of Public Health, Faculty of Applied Medical Sciences, Albaha University, Albaha, Saudi ArabiaCorrespondence: Hassan A Hamali, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Gizan, 45142, Saudi Arabia, Email hhamali@jazanu.edu.saBackground: Procoagulant microvesicles (MVs) are submicron membrane fragments released from activated cells and cells undergoing apoptosis. The procoagulant activity of MVs is enhanced in the presence of tissue factor (TF). MVs and TF are active mediators that induce pro-inflammatory response and prothrombotic tendency and have been linked to the severity of several disorders, including malaria infection. The current study aimed to measure the levels of circulating procoagulant MVs and TF-bearing MVs in malaria patients and correlate these levels with other hematological parameters and parasitemia.Materials and Methods: Levels of MVs and TF-bearing MVs in the plasma of children and adult patients infected with Plasmodium falciparum were measured alongside matched healthy controls.Results: Patients with Plasmodium falciparum infection had ~3.8 times MVs (p < 0.0001) and ~13.0 times TF-bearing MVs compared to the matched healthy controls. MVs showed inverse significant correlation with platelet count (p = 0.0055), hemoglobin (p = 0.0004) and parasitemia.Conclusion: Elevated levels of MVs and TF-bearing MVs could be useful biomarkers to evaluate the procoagulant activity, inflammatory response and parasitemia levels in malaria infection, aiding in better management of the disease.Keywords: procoagulant, microvesicles, tissue factor, malaria, prothrombotic inflammation

Hassan A Hamali,1 Muhammad Saboor,1,2 Gasim Dobie,1 Aymen M Madkhali,1 Mohammad S Akhter,1 Ali Hakamy,3 Hesham M Al-Mekhlafi,2 Denise E Jackson,4 Yahya H Matari,5 Abdullah A Mobarki1 1Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 2Medical Research Center, Jazan University, Gizan, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 4Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Bundoora, VIC, Australia; 5Laboratory Department, Baish General Hospital, Gizan, Saudi ArabiaCorrespondence: Hassan A Hamali, Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Gizan, 45142, Saudi Arabia, Tel +966173295000, Email hhamali@jazanu.edu.saBackground: The hypercoagulability and thrombotic tendency in coronavirus disease 2019 (COVID-19) is multifactorial, driven mainly by inflammation, and endothelial dysfunction. Elevated levels of procoagulant microvesicles (MVs) and tissue factor–bearing microvesicles (TF-bearing MVs) have been observed in many diseases with thrombotic tendency. The current study aimed to measure the levels of procoagulant MVs and TF-bearing MVs in patients with COVID-19 and healthy controls and to correlate their levels with platelet counts, D-Dimer levels, and other proposed calculated inflammatory markers.Materials and Methods: Forty ICU-admitted patients with COVID-19 and 37 healthy controls were recruited in the study. Levels of procoagulant MVs and TF-bearing MVs in the plasma of the study population were measured using enzyme linked immunosorbent assay.Results: COVID-19 patients had significantly elevated levels of procoagulant MVs and TF-bearing MVs as compared with healthy controls (P< 0.001). Procoagulant MVs significantly correlated with TF-bearing MVs, D-dimer levels, and platelet count, but not with calculated inflammatory markers (neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and platelet/neutrophil ratio).Conclusion: Elevated levels of procoagulant MVs and TF-bearing MVs in patients with COVID-19 are suggested to be (i) early potential markers to predict the severity of COVID-19 (ii) a novel circulatory biomarker to evaluate the procoagulant activity and severity of COVID-19.Keywords: microvesicles, tissue factor, procoagulant, D-dimer, NLR, PLR, PNR, COVID-19

Abdullah A Mobarki,1 Gasim Dobie,1 Muhammad Saboor,1,2 Aymen M Madkhali,1 Mohammad S Akhter,1 Ali Hakamy,3 Adel Humran,4 Yousof Hamali,5 Denise E Jackson,6 Hassan A Hamali1 1Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 2Medical Research Center, Jazan University, Gizan, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 4Respiratory Care Department, King Fahad Central Hospital, Gizan, Saudi Arabia; 5Radiodiagnostics and Medical Imaging Department, Prince Sultan Medical City, Riyadh, Saudi Arabia; 6Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Bundoora, VIC, AustraliaCorrespondence: Hassan A HamaliDepartment of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Gizan, 45142, Saudi ArabiaTel +966581155585Email hhamali@jazanu.edu.saObjective: The aims of the current study were to evaluate the importance of MPR and NLR as prognostic markers in ICU-admitted COVID-19 patients and to investigate the impact of COVID-19 on hematological and coagulation parameters in patients from Jazan region of Saudi Arabia.Methods: This retrospective study was conducted between October 2020 and January 2021 at King Fahad Central Hospital, Jazan region. Medical files, which included the results of complete blood count (CBC), calculated mean platelet volume to platelet count ratio (MPR) and neutrophils-to-lymphocytes ratio (NLR) parameters, coagulation profile and D-dimer test, of 96 (64 male and 32 female) COVID-19-infected patients admitted to the intensive care unit were reviewed. Associations between the test results and COVID-19 infection outcomes (discharged [DC] or passed away [PA]) were measured.Results: The results of the current study demonstrate overall significant differences in CBC parameters between PA group as compared to DC group (P < 0.05). The PA group had a significantly elevated MPR (10.15± 12.16 vs 4.04± 1.5; P < 0.01) and NLR (18.29± 19.82 vs 7.35± 9.68; P < 0.01) as compared to the DC group, suggesting an association between these parameters and mortality. Odds ratios analysis also showed that adjustment for demographic variables and comorbidities did not weaken the observed association.Conclusion: Elevated MPR and NLR are associated with poor prognosis in COVID-19 patients and could be useful as therapy management indicators.Keywords: COVID-19, NLR, MPR, ICU, CBC, mortality

Muhammad Saboor,1,2 Amtuz Zehra,3 Hassan A Hamali,1 Amr Jamal Halawani,1 Abdullah A Mobarki,1 Aymen M Madkhali,1 Saleh Abdullah1 1Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Medical Research Centre (MRC), Jazan University, Jazan, Saudi Arabia; 3Basic Science Department, King Saud Bin Abdulaziz University, Al Ahasa Branch, Saudi ArabiaCorrespondence: Muhammad SaboorDepartment of Medical Laboratory Technology, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi ArabiaTel +966 54 495 9029Email msaboor@jazanu.edu.saPurpose: A2 and A2B are rare phenotypes of the ABO blood group system. Some individuals with A2 and A2B may have anti-A1 antibodies that may be clinically significant or insignificant. The aim of this study was to determine the frequency of A2, A2B phenotypes and anti-A1 antibodies in blood donors in Jazan, Saudi Arabia. This study also evaluated the reactivity potential of anti-A1 antibodies.Materials and Methods: Blood samples collected from 446 blood donors were typed for ABO (cell and serum grouping) and Rh D. Individuals with blood group A and AB were further subtyped by testing with anti-A1 lectin. In addition to the serum grouping using A1 red cells, A2 and A2B individuals were screened for the presence of anti-A1 in their sera against A1 red cells at 4°C, 22°C and 37°C to determine the thermal amplitude of the reacting anti-A1 antibody (if present).Results: Among A and AB, A1 was the commonest phenotype (20.2%, n=90 out of 446) while A1B was found to be 1.8% (n=8) among AB phenotype. A2 and A2B were found to be 2.2% (n=10) and 0.9% (n=4), respectively. Only one individual with A2B blood type showed cold reactive anti-A1 antibody, the strength of which was 32.Conclusion: A2 and A2B were the rarest among ABO phenotypes in the studied population. Although rare, anti-A1 antibody is not so uncommon. Care shall be taken during routine ABO grouping especially in cases of mix-field or weak positive reactions in A and AB phenotypes.Keywords: ABO, anti-A1, subgroups, blood groups, antibodies, Saudi Arabia

Hassan A Hamali, Abdullah A Mobarki, Muhammad Saboor, Aymen Alfeel, Aymen M Madkhali, Mohammad S Akhter, Gasim Dobie Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi ArabiaCorrespondence: Hassan A HamaliDepartment of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Gizan 45142, Saudi ArabiaTel +966581155585Email hhamali@jazanu.edu.saPurpose: Anemia is one of the most common disorders affecting the population in both low-income and developing countries. This study aimed to determine the prevalence of anemia and iron deficiency in apparently normal male and female students of Jazan University, Saudi Arabia.Material and Methods: This cross-sectional study was conducted at the Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia. One hundred thirty-four (85 males and 49 females) healthy students with no outward signs of illness were recruited. A specific questionnaire related to sociodemographic and health characteristics was designed and validated. The collected samples were analyzed for complete blood count, serum iron, and serum ferritin.Results: In the male group, 81 participants (95.3%) were nonanemic with normal hemoglobin (14.99 ± 1.11g/dl), whereas only 4 males were anemic (hemoglobin < 13.0 g/dl). On the other hand, anemia was more prevalent in female students, as 67.35% had hemoglobin values less than 12.0 g/dl. In addition, 26.54% of the anemic females had low serum iron and serum ferritin, indicating iron-deficiency anemia. Although the majority of male participants had normal hemoglobin levels, 37.6% of them had low mean cell volume (MCV), low mean cell hemoglobin (MCH), low mean cell hemoglobin concentration (MCHC), and high red blood cell (RBC) counts, suggesting thalassemia.Conclusion: Anemia, in particular iron-deficiency anemia, was found to be highly prevalent in females, whereas more than one-third of the male participants might be carriers of alpha or beta thalassemia. Additionally, low dietary iron intake and irregular meal consumption could be two of the possible causes of anemia in the study population. Conducting this study on a large scale of male and female students from different faculties of Jazan University will provide in-depth details about the prevalence and types of anemia among them.Keywords: anemia, iron deficiency, students, Jazan University