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Background: Macrocephaly, hypotonia, developmental delay, intellectual disability with delayed expressive speech, behavioral issues, a distinct facial phenotype, radiographic abnormalities, and impaired glucose metabolism are characteristics of the Primrose syndrome. As a result, Primrose syndrome is identified in a proband with typical symptoms and a heterozygous pathogenic mutation in ZBTB20 identified by molecular genetic testing. Case presentation: A seven-year-old girl presented with a history of not speaking consistently, snoring and mouth breathing. The patient was responding to sound and there was presence of adenoid hypertrophy. Four years later, the patient presented with developmental delay, delayed speech and problem sleeping. Whole exome sequencing (WES) was done and the result showed a likely heterozygous pathogenic variant, c.11+1del, in the ZBTB20 gene. As advised, management includes educational programs, physiotherapy, speech therapy, and occupational therapy. Conclusion: Patients must have their growth and development followed every six months, their speech and developmental needs evaluated every six months, their behavioural issues, neurological, and musculoskeletal conditions evaluated at every visit, their brain stem evoked response audiometry evaluated annually, and their thyroid function and insulin-resistant diabetes tested annually. Keywords: Heterozygous, Mutation, ZBTB20, Primrose, syndrome, Jeddah

Background: Excessive internet usage is a worldwide problematic issue among young adults and college students. Previous studies showed that Saudi young adults are involved in this problem. Objectives: To determine the prevalence of Internet Addiction (IA), and to find out its relation with depressive symptoms, sleep quality, and demographic variables. Methods: This study used a cross-sectional design. Data were collected from 341 nursing students in Saudi Arabia using three scales: Young’s Internet Addiction Test, Central Epidemiologic Scale for Depression and Pittsburgh Sleep Quality Index. Results: The results showed that 35.1% of students were suffering from frequent problems and 0.9% were suffering from significant problems due to heavy internet usage. The correlation results found a positive moderate correlation between IA and depression (r = 0.401, p < 0.001) and a positive weak correlation with sleep quality (r = 0. 196, p = 0.002). Sleeping and depression were weakly correlated (r = 0.274, p < 0.001). Regression analysis revealed that IA was associated with: smoking status, high family income, duration of usage (3-6 hours and >6 hours), and depressive symptoms. The depressive level was associated with duration of usage (>6 hours), students’ grading point average (GPA), IA, and sleep quality. Sleep quality was found to be associated with duration of usage (>6 hours) and having depressive symptoms. Conclusion: The findings illustrate the need for proper management of internet usage, as well as developing plans to avoid the negative consequences of internet addiction on psychological wellbeing by incorporating nursing education programs about appropriate internet usage.

الملخص: أهداف البحث: إن الهدف من هذه الدراسة هو استكشاف أنواع الإساءة اللفظية، وتكرارها لدى طلبة التمريض المتدربين وتحديد مدى تفشي الاكتئاب والضغط النفسي والقلق بينهم. طرق البحث: أجريت دراسة مقطعية في مستشفى تعليمي في أحد المناطق الحضرية في المملكة العربية السعودية لجمع البيانات من طلاب التمريض المتدربين باستخدام استبانة الإساءة اللفظية واستبانة الاكتئاب والقلق والضغط النفسي. النتائج: أكمل ٥٤ متدربا الاستبانات، وتعرض ٥٥٪ منهم لنوع واحد من الإساءة اللفظية مرة واحدة على الأقل في العام، و٥٪ تعرضوا لعدة مرات في الأسبوع. التجاهل كان الشكل الأكثر شيوعا من أشكال الإساءة اللفظية بنسبة ٥٠.٨٪، وكان رد الفعل العاطفي الأكثر شيوعا هو الشعور بالقهر بما نسبته ٥١.١٪. بالنسبة لرد الفعل السلوكي، كان ''التوقف عن التحدث إلى الشخص المعتدي'' هو رد الفعل الأكثر تكرارا، والذي يقوم به المتدربون بنسبة ٥٧.٩٪. معظم المتدربين) ٥٩.٣ ٪ (لم يظهروا أي من علامات الاكتئاب، و١٨.٥٪ منهم عانوا من اكتئاب شديد إلى حاد. معظم المتدربين (٧٠.٤٪) لم يعانوا من أي علامات تدل على القلق، ونحو ١١٪ منهم كان لديهم قلق شديد إلى حاد. لم يكن لدى الغالبية (٧٠.٤٪) أي علامات للضغط النفسي، فقط ٥.٦٪ منهم عانوا من التوتر الشديد. الاستنتاجات: الإساءة اللفظية هي مصدر قلق كبير في أماكن التدريب السريري. تحديد مستواها وأشكالها وردود الأفعال أمرا مهما، لا سيما بين ممرضي المستقبل. Abstract: Objective: This study aimed to investigate the forms and frequency of verbal abuse (VA) among nursing student interns and determine the prevalence of psychological disorders (i.e. depression, stress, and anxiety) within this group. Materials and methods: A cross-sectional study was conducted in an urban teaching hospital in KSA. Nursing student interns responded to the Verbal Abuse Questionnaire and Depression Anxiety Stress Scales. Results: A total of 54 interns completed the questionnaires; 55% of them had been exposed to one type of VA at least once a year, and 5% of them had experienced VA several times a week. ‘Ignoring’ was the most frequently experienced form of VA (50.8%), and feeling overwhelmed was the most commonly experienced emotional reaction (51.1%) to VA. ‘Stop talking to the abusive person’ was the most frequently reported behavioural reaction to VA (57.9%). Most of them (59.3%) did not report a sign of depression, but 18.5% of them had severe to extremely severe depression. Most interns (70.4%) did not report a sign of anxiety, but approximately 11.1% of them had severe to extremely severe anxiety. A majority (70.4%) of the interns did not report a sign of stress, and only 5.6% of them reported experiencing severe stress. Conclusion: VA is a major problem that is encountered in clinical settings, especially by future nurses. The present findings underscore the need to further examine the levels and forms of VA that are experienced by them and their reactions to such stress-inducing behaviours. الكلمات المفتاحية: الإساءة, المتدرب, الاضطراب النفسي, اللفظية, التمريض, Keywords: Abuse, Intern, Psychological disorder, Stress, Verbal abuse

Background Pregnant women go through physiological as well as psychological changes during pregnancy. Antenatal anxiety disorders are common, with proven adverse maternal and fetal outcomes. Anxiety increases the risks for prematurity and neurodevelopmental disorders. This study aimed to estimate the prevalence of pregnancy-related anxiety and the impact of social media among pregnant women in Al-Ahsa, Saudi Arabia. Materials and methods This observational cross-sectional study included pregnant women who were attending antenatal care (ANC) in primary healthcare centers between May and October of 2021 in Al-Ahsa, Saudi Arabia. For data collection, a structured self-administered questionnaire was distributed randomly to eligible pregnant women. The presence of pregnancy-related anxiety was assessed by using the 10-item Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R), Arabic version. The impact of social media was measured through Social Media Engagement Questionnaire (SMEQ). Results Out of 823 pregnant women, 382 were eligible. Their mean age was 26.1 ± 10.9 years. Most of them (70.4%) had adhered to ANC. However, 32.1% had a history of miscarriage, and 6.7% had previous birth with congenital anomalies. The mean scores of pregnancy-related anxiety domains were 10.6 out of 15 for fear of giving birth, 8.7 for concern of own appearance, and 6.4 out of 12 for worries about bearing a handicapped child. More than half of the participants scored 28 out of 50 for pregnancy-related anxiety. The factors that were significantly associated with pregnancy-related anxiety were healthcare workers, first trimester, and unplanned pregnancy (P < 0.05). Social media engagement showed no correlation with anxiety. Conclusions The pregnancy-related anxiety level was average among pregnant women in Al-Ahsa, and fear of giving birth was the most common reason. Its predictors included early pregnancy, being a healthcare provider, and unplanned pregnancy. Pregnancy-related anxiety should be diagnosed early during routine ANC for better maternal and fetal outcomes.

Introduction Mental stigma is when patients of mental illness are labeled by their disorders, viewed negatively, and discriminated against due to their illness. This has a big impact on people's attitudes and behaviors toward the mentally ill. Moreover, mental stigma leads people to avoid patients with mental health issues, blame them for their conditions, and associate them with negative features like being dangerous, unpredictable, and hard to communicate with. The primary objective of this study is to assess the mental stigma among the population of the Al-Ahsa region in Saudi Arabia. Methods This is a cross-sectional study conducted in Al-Ahsa, Saudi Arabia, between June and August 2021. The target population of the study was people aged 18-65 years old whose place of residency during the time of the study was Al-Ahsa. The questionnaire used in this study contained a mental stigma scale called community attitudes toward mental illness (CAMI). Results A total of 758 participants were enrolled in the study. The mean of the stigma score was 99.24 ± 15.622, with a minimum of 53 and a maximum of 176. The means of the subscales were as follows: authoritarianism (26.18 ± 4.420), benevolence (23.26 ± 4.762), community mental health ideology (24.66 ± 5.896), and social restrictiveness (25.13 ± 4.6). There was a positive relationship between age and stigma score. Healthcare workers were found to have a lower level of stigma, as were those who spoke more languages. Also, being diagnosed with a mental illness and knowing someone who is diagnosed with a mental illness were associated with a lower level of stigma. Conclusion Most of the population (91.96%) had a low to medium-low level of stigma. The variables found to affect the level of stigma were age, career, number of spoken languages, being diagnosed with a mental illness, and knowing someone who is diagnosed with a mental illness. Mental stigma has a great impact on the person, as it can prevent the patient from seeking help, lead to isolation, and suicidal ideation. Future stigma-targeted campaigns are recommended.

Background: Cerebral venous sinus thrombosis (CVST) secondary to nephrotic syndrome (NS) is rarely reported. Additionally, treating steroid-sensitive nephrotic syndrome (SSNS) that changes to steroid resistance (SRNS) is difficult, with many relapses and side effects. Case presentation: A 32-month-old SSNS male child turned into SRNS and developed cerebral venous sinus thrombosis (CVST), a rare complication of NS. As a result of the administration of combined pulse methylprednisolone and IV Rituximab (RTX) therapy, the patient showed marked improvement, the results of urine analysis were remarkably improved, and the child started to respond to treatment. Conclusions: Successful treatment of a rare case of juvenile SSNS behaving as SRNS with the development of CVST could be established using combined steroid pulse therapy, Enoxaparin, and the B lymphocytes monoclonal antibodies RTX.

Introduction: Pulmonary embolism (PE) is a common and sometimes fatal disease. It is due to obstruction of a pulmonary artery or one of its branches by material (e.g., thrombus, tumor, air, or fat) that originated elsewhere in the body. Objective: To review and evaluate the potentially serious adverse effects of prolonged use of combined oral contraceptive pills in a 50-year-old woman. Case Presentation: A 50-year-old Saudi female admitted to our hospital,(King Fahad hospital Alhfuof) with an eight-day history of right leg swelling associated with pain, she is not known diabetic or hypertensive. She is para8 with no history of abortion and she was using oral contraceptive pills for the past fourteen years. Diagnosis of deep Vein thrombosis was made by color duplex ultrasonography. She was started on enoxaparin sodium 70 mg twice per day and warfarin 5 mg daily. She improved and the INR was in the therapeutic range in Day 5 of admission it was 2.2; but she developed dyspnoea, chest pain and had tachycardia. CT pulmonary angiography and showed an acute pulmonary embolism in the right pulmonary artery. The patient was transferred to the intensive care unit and managed with high flow oxygen and low molecular weight heparin was continued and the warfarin dose was increased; she became well without significant sequelae and was discharged from hospital in good condition. Conclusion: This case illustrates the development of a life-threatening condition such as pulmonary embolism as a result of prolonged use of combined oral contraceptive pills in a 5o-year-old woman. Keywords: Deep Vein thrombosis; pulmonary embolism; oral contraceptive pills.

Background:This paper explores the opportunities and challenges for integrating patient safety education in undergraduate nursing curriculum.Methods:Four dimensions of undergraduate nursing education are examined: National accreditation of nursing programs, building a competency-based nursing education, a model of nursing education and building faculty capacity in patient safety education and research.Results:Incorporating patient safety in a nursing curriculum can be “institutionalized” by making it a pre-requisite for granting program accreditation. At the operational level, transforming undergraduate nursing education to incorporate inquiry-based learning and moving toward competency-based patient safety education are two key requirements for engaging the students with patient safety science. Building faculty capacity who are experts in both patient safety teaching and research remains a key challenge that needs to be addressed to enable a shift in the patient safety “mindset” for future nursing workforce.Conclusion:Efforts to introduce patient safety in nursing education are both necessary and timely, and should accommodate students’ unique needs and cultural context.

INTRODUCTION: Nursing students suffer from high levels of stress related to academic assignments in addition to clinical skills training. As a psychosocial phenomenon, stress affects students’ academic achievement and wellbeing. Coping mechanisms help students deal with the challenges arising from stress.AIMS: To illustrate the level of stress and common stressors among nursing students; to describe the difference in stress level related to demographic data; and to identify coping mechanisms used by nursing students.METHODS: A descriptive cross-sectional study was carried out to determine the type of stress and coping strategies among nursing students. The level of stress was evaluated through Perceived Stress Scale (PSS) and type of coping strategies were assessed by use of Coping Behaviours Inventory (CBI).RESULTS: Students perceived moderate level of stress, most commonly attributed to assignments and workload, teachers and nursing staff, peers and daily life, and taking care of patients. The most frequently used coping mechanism was problem solving. The study found that age, GPA, education level and residence are good predictors of the use of transference as a coping behaviour.CONCLUSION: A moderate level of stress among students illustrates the need for stress management programs and the provision of suitable support.