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Organ donation is an integral part of medical ethics worldwide, including Saudi Arabia. Although the Saudi community has a positive attitude toward the concept of organ donation and transplantation, several factors prevent people from agreeing to donate organs and tissues. This study aimed to explore and evaluate the knowledge and attitudes medical students in the Eastern Province of Saudi Arabia have toward organ donation and transplantation.A cross-sectional study among 722 medical students in the Eastern Province. The questionnaire consisted of 3 parts: sociodemographic questions, organ donation and transplantation knowledge questions, and questions on attitudes toward organ donation and reasons for consenting or refusing to donate.Both men and women had positive attitudes toward organ donation. The level of knowledge of organ donation and related procedures did not differ significantly among men (13.07%) and women (13.60%) (P.027). The motives for donation were the desire to help others (88.8%) (P = .02) and sympathy (59.8%). The main source of information on organ donation for respondents was television, followed by the internet and relatives and/or friends.While medical students are generally supportive of organ donation and transplantation, they may lack basic knowledge on organ donation. Due to lack of basic knowledge, they become hesitant to make the decision to donate. It is recommended that additional organ donation modules be included in the student curriculum to increase the knowledge of future health care providers. Most of the participants would not change their attitudes toward organ donation based on the Saudi government initiatives to register for the Saudi Center for Organ Transplantation organ donation program.

Background Screening is a cancer prevention measure for groups who are asymptomatic, and diagnosis is a medical test for groups who are symptomatic. The occupational privilege of health care providers (HCPs) is expected to play a positive role in cancer screening practices. Therefore, this study aimed to assess perceptions and personal attitudes of HCPs regarding their decision to screen for cancer in the Eastern Province of Saudi Arabia. Design A cross-sectional multicenter survey study was conducted. A well-designed and validated questionnaire was distributed to the HCPs at three tertiary hospitals in the Eastern Province of Saudi Arabia. Results Out of 900 health care providers who received the questionnaire, 372 completed it. Two-thirds, 247 (66.4%) of them were nurses and the rest were physicians and the mean age was 34.1 ± 7.1 years. Regardless of gender, profession, or age, the overall rate of belief in the importance of regular cancer screening was high; 91.4%. The number of participants who did not screen for colonoscopy was significantly higher than those who screened. The number of females in the age group of between 45 and 54 years who screened with mammography was significantly higher than non-screened. In a similar way, male HCPs above 54 years who got themselves screened for Prostate-Specific Antigen (PSA) were significantly higher than those who did not. Conclusions Findings of the current research and existing evidence specifically for the Saudi community indicated a need to raise awareness, emphasizing the role of HCPs in motivating themselves, their families, and their patients to implement various cancer screening programs.

Background: Acute Respiratory Distress Syndrome (ARDS) is caused by non-cardiogenic pulmonary edema and occurs in critically ill patients. It is one of the fatal complications observed among severe COVID-19 cases managed in intensive care units (ICU). Supportive lung-protective ventilation and prone positioning remain the mainstay interventions. Purpose: We describe the severity of ARDS, clinical outcomes, and management of ICU patients with laboratory-confirmed COVID-19 infection in multiple Saudi hospitals. Methods: A multicenter retrospective cohort study was conducted of critically ill patients who were admitted to the ICU with COVID-19 and developed ARDS. Results: During our study, 1154 patients experienced ARDS: 591 (51.2%) with severe, 415 (36.0%) with moderate, and 148 (12.8%) with mild ARDS. The mean sequential organ failure assessment (SOFA) score was significantly higher in severe ARDS with COVID-19 (6 ± 5, p = 0.006). Kaplan–Meier survival analysis showed COVID-19 patients with mild ARDS had a significantly higher survival rate compared to COVID-19 patients who experienced severe ARDS (p = 0.023). Conclusion: ARDS is a challenging condition complicating COVID-19 infection. It carries significant morbidity and results in elevated mortality. ARDS requires protective mechanical ventilation and other critical care supportive measures. The severity of ARDS is associated significantly with the rate of death among the patients.

There is extensive literature on theoretical arguments and fundamental subjects for the study of bioethics challenges from Saudi healthcare providers’ perspective. Some of the core principles of end-of-life care in Saudi Arabia are respect for dignity of both the patient and the caregiver; compassion to the wishes of the patient and family; management of pain; assessment and management of the psychological and social needs of the patient and the family. However, healthcare professionals often neglect good clinical practice by failing to comply with informed consent. This insensibility leads to the reluctance of patients being aware of the procedures, although they have expressed an interest in decision-making process. The collective engagement of family and health care professionals is the ultimate level of success. Future research and education should involve healthcare professionals, patients, and their families in decision-making by providing the knowledge empowering intelligence on how to communicate with sensitivity, dignity, sympathy, and respect.

The high prevalence of overweight and obesity is a major contributor to the global burden of disease, and create an economic burden for nations, including both direct and indirect costs. Although the Kingdom of Saudi Arabia is rapidly industrializing and the economy is now less dependent on oil, oil industry is still the main contributor to the Saudi labor force (41%). However, the productivity growth lags behind many developing countries. No studies have been conducted to explore the factors that can be associated with the lower productivity in this population of Saudi Arabia. This study aimed to estimate the prevalence of overweight/obesity and examine the association between overweight/obesity and lifestyle habits among employees of petrochemical manufacturing companies in the Kingdom of Saudi Arabia. A total of 1000 employees were surveyed. Chi-square test and logistic regression were used to predict odds ratios for obesity. About 47% of the sample was normal weight, while 28.5% was overweight and 21.2% was obese. Four factors were found to be predictive of obesity: feelings about weight, age, marital status, and childhood region. More than 52% of employees reported being happy with their weight. Those unhappy with their weight had more than six times greater odds of obesity as compared to those happy with their weight. Married employees were about twice as likely as unmarried to be obese. The findings of high prevalence of overweight and obesity among employees of petrochemical manufacturing suggest that more efforts are needed to promote healthy behaviors among employees. Workplace wellness programs and educational campaigns are recommended to encourage healthy lifestyle habits at both the workplace and in the community.

Background Over the past few years, five domains of importance about the current state of bioethics in Saudi Arabia have shaped the perspective of most research: doctor-patient relationship, informed consent, do-not-resuscitate, organ donation, and transplantation, medical students’ knowledge and attitudes about medical ethics curriculum. This systematic review aimed to systematically identify, compile, describe and discuss ethical arguments and concepts in the best-studied domains of bioethics in Saudi Arabia and to present cultural, social, educational, and humane perspectives. Methods Six databases were searched using Boolean operators (PubMed, Embase, Web of Science, Scopus, CINAHL, Google Scholar) from December 2020–June 2021. The search and report process followed the statement and flowchart of preferred reporting items for systematic reviews and meta-analyses (PRISMA). Resutls The search resulted in 1651 articles, of which 82 studies were selected for a final review and assessment. There is a gradual increase in research, whereby a substantial increase was observed from 2017. Most of the published articles focused on ‘Organ Donation & Transplantation’ with 33 articles, followed by ‘Doctor-Patient Relations’ with 18 publications. Most of the published articles were from Central Province (33), followed by Western Province (16). The authorship pattern showed a collaborative approach among researchers. The thematic analysis of keywords analysis showed that ‘Saudi Arabia,’ ‘attitude PHC,’ ‘organ donation,’ ‘knowledge and education,’ and ‘donation’ have been used the most commonly. Conclusion This systematic quantitative synthesis is expected to guide researchers, stakeholders, and policymakers about the strengths and gaps in knowledge and attitudes regarding medical ethics in Saudi Arabia, both among the general public and health professionals.

This study aimed to explore the association of turnover-attachment motive with socio-demographic data among Saudi and foreign nurses in a hospital in the Eastern Province of Saudi Arabia.A cross-sectional correlation study was conducted among n = 180 registered Saudi and foreign nurses working at a private tertiary hospital in the Eastern Province, Saudi Arabia. The turnover-attachment motive survey was used to evaluate the eight motivational forces. Data were analysed using JASP version 16 statistical software and Orange 3 version 3.26.0. The data were subjected to correlation analysis and multiple linear regression.Only 8% of participants were identified with a high intention to leave driven by alternative, behavioural, normative and constitutive forces. Younger healthcare workers tend to have higher intentions to quit the job; the 29-33 age group has a statistically significant negative effect, increasing intention to leave. It was found that those with 5-6 years of clinical experience at Dr. Sulaiman Al Habib Hospital, Al Khobar and no experience abroad had statistically significantly lower intention to leave.This study presented the factors influencing nursing staff to stay or leave work in a hospital in the Eastern Province of Saudi Arabia that can be a basis for reviewing existing policies and procedures to improve nurses' working conditions.

A satisfactory patient care culture model can help improve most patients’ quality of care in a hospital. This study aims to improve patients’ experiences (PX) by implementing a culture model at King Abdul-Aziz Armed Forces Hospital in Dhahran, Saudi Arabia. To achieve the research aim, a set of interventions were implemented that included a patient and family advisory council, empathy training, recognition of the PX, leadership–patient interviews, PX champions and quality improvement. These interventions were further measured using the Hospital Consumer Assessment of Healthcare Providers and Systems survey in the inpatient, outpatient and emergency departments. The improvement project was conducted in 2020, focusing mainly on transforming the culture and launching activities targeting specific touchpoints identified as priority areas. After making these changes, the hospital saw improvements in all patient relationships, with an average score across all dimensions collectively increasing by more than 4%. The quality improvement project using the PX culture model approach demonstrated significant improvements. In addition, employee involvement in patient care has become a significant factor in improving the quality of care. The critical elements for improving the PX and culture included recognising staff and creating networks across the system through effective leadership, employee engagement and engagement of patients and their families.

Iron-refractory iron deficiency anemia (IRIDA) is considered an autosomal recessive iron deficiency anemia due to mutations in the transmembrane protease serine 6 (TMPRSS6) gene. Variations in iron parameters and a higher risk of iron deficiency have been linked to the TMPRSS6 mutations. Furthermore, human genome-wide association studies (GWAS) identified a common mutation (rs855791) linked to abnormal hematological parameters, highlighting the importance of the TMPRSS6 gene in the regulation of iron homeostasis. This is the first study to investigate TMPRSS6 gene mutation in six Saudi families of probands with iron deficiency anemia unresponsive to oral iron and partially responsive to parenteral iron administration. Each participant provided a vacutainer tube with three blood samples (2.5 ml each) and analyzed based on hematological, biochemical iron profiles, and followed by genotyping by PCR. The TMPRSS6 gene was amplified, sequenced, and analyzed in all probands and family members. Statistical analysis was done using SPSS and SHEsis software. Few functional mutations in these families were suggested (p.W73X, p.E523K and p.V736A). The proband of family 6 presented numerous hematological abnormalities upon initial consultation, including normocytic anemia accompanied by low Hb, normal MCV, low serum iron, low serum ferritin, and normal TIBC. While the p.W73X variant was only found in 2 families, the p.V736A variant was found in all examined Saudi families with IRIDA. Given the evidence outlined for these six cases, future genotype-phenotype correlation studies in a large number of IRIDA patients in Saudi Arabia may be very informative for patient management, in addition to increasing knowledge of TMPRSS6 function during development as well as factors in the regulation of TMPRSS6 and its effect on iron levels in the body.

The economic impact of the COVID-19 pandemic on global health systems is a major concern. To plan and allocate resources to treat COVID-19 patients and provide insights into the financial sustainability of healthcare systems in fighting the future pandemic, measuring the costs to treat COVID-19 patients is deemed necessary. As such, we conducted a retrospective, real-world observational study to measure the direct medical cost of treating COVID-19 patients at a tertiary care hospital in Saudi Arabia. The analysis was conducted using primary data and a mixed methodology of micro and macro-costing. Between July 2020 and July 2021, 287 patients with confirmed COVID-19 were admitted and their data were analyzed. COVID-19 infection was confirmed by RT-PCR or serologic tests in all the included patients. There were 60 cases of mild to moderate disease, 148 cases of severe disease, and 79 critically ill patients. The cost per case for mild to moderate disease, severe disease, and critically ill was 2003 USD, 14,545 USD, and 20,188 USD, respectively. There was a statistically significant difference in the cost between patients with comorbidities and patients without comorbidities (P-value 0.008). Across patients with and without comorbidities, there was a significant difference in the cost of the bed, laboratory work, treatment medications, and non-pharmaceutical equipment. The cost of treating COVID-19 patients is considered a burden for many countries. More studies from different private and governmental hospitals are needed to compare different study findings for better preparation for the current COVID-19 as well as future pandemics.

The COVID-19 pandemic caused by SARS-CoV-2 has resulted in millions of cases and hundreds of thousands of deaths. Beyond there being no available antiviral therapy, stimulating protective immunity by vaccines is the best option for managing future infections. Development of a vaccine for a novel virus is a challenging effort that may take several years to accomplish. This mini-review summarizes the immunopathological responses to SARS-CoV-2 infection and discusses advances in the development of vaccines and immunotherapeutics for COVID-19.

This article transcribes an interview with the great Polish composer Krzysztof Penderecki and is one of the last interviews that Penderecki gave before his death on 29 March 2020. It traces the composer's career, from his early musical education to the Ninth Symphony on which he was working at the time of his death, and focuses on the composition of his Threnody for the Victims of Hiroshima, the St Luke Passion and the Polish Requiem.

Gastric Cancer is a heterogeneous, multifactorial, aggressive disease that has been and still remains one of the most common causes of cancer-related death and a major public health issue worldwide. Currently, gastric cancer shows decreasing trends in its incidence and mortality in some geographic areas; however the disease still shows poor prognosis and remains difficult to cure. The prognosis for patients with gastric cancer depends on the stage at which the gastric cancer is detected, and complete excision of the cancer is the only proven curative option. However, recently the treatment of gastric cancer has been rapidly evolving with the emergence of new cytotoxic drugs and molecular targeted agents that show promising response rate and disease progression-free survival. Cancer prevention intervention such as screening to ensure early detection, population health education, anti-cancer knowledge popularization, identification and correction of unhealthy lifestyles has demonstrated to be effective; and improved treatment modalities can dramatically increase the poor prognosis for patients with gastric cancer. Demographic, ecological, environmental, culture, and genetic variables all contribute to the heterogeneity of gastric cancer; however, environmental risk factors play an important role throughout all the stages of the disease progression, management and surveillance. In this review, we address the role of important environmental risk factors in the onset of gastric cancer, and highlight the current treatments modalities and prevention measures for gastric cancer.

Background: Low back pain (LBP) is a complex condition with several determinants contributing to its occurrence. LBP is defined as pain that persists for 12 weeks or longer. The prevalence of work-related LBP among health-care personnel in Saudi Arabia affects both the healthcare personnel and the quality of patient care. Aim: The aim of this study was to review the epidemiology of LBP among the healthcare personnel in Saudi Arabia and wellness programs aimed at decreasing the rate of LBP. Methods: A systematic literature search was conducted using relevant keywords to search for studies conducted in Saudi Arabia regarding LBP among healthcare personnel. After selecting the inclusion criteria and epidemiological measures of LBP for the current research as well as obtaining full texts for the study, a total of 13 articles were used. Results: Thirteen studies were included in the current systematic review. Nurses and dentists were among the most vulnerable groups, constantly experiencing LBP due to long working hours, standing, as well as stress. Physical and occupational therapists and surgeons were experiencing LBP and generalized myalgia due to the work stress caused by the overcommitment at work and a high number of treated patients. Emergency medical services personnel reported a very high prevalence of musculoskeletal disorders. Based on the results of the reviewed studies, most of the participants experienced the prevalence of the LBP within the last 12 months. Conclusion: LBP has multifactorial risks, etiology, and increased evidence and prevalence among healthcare personnel in Saudi Arabia. The results show that there is good reason to conduct an in-depth study of available best practice interventions aimed at preventing LBP among healthcare personnel. Future studies in Saudi Arabia should focus on creating workplace wellness programs and on assessing risk factors as well as preventing LBP.

This study aimed to assess the psychosocial impact of sickle cell disease (SCD) and diabetes mellitus on children and their parents in Sudan, and the relationship between socioeconomic status and psychosocial issues. A descriptive, cross-sectional study was conducted among n = 320 children aged 6–12 years, of whom n = 170 were diagnosed with SCD, n = 150 children with diabetes mellitus and their parents. The strengths and difficulties questionnaire (SDQ scale) was used to assess the psychosocial aspect of children. Depression, Anxiety, Stress Scale -21 Items (DASS 21) was used to assess the psychological well-being of the caregivers. Data on psychological problems of children with SCD showed that 66.5% had emotional symptoms, 18.2% had conduct problems and 19.4% hyperactivity. Data of parents showed that 45.9% of parents did not experience depression; 27.9% were moderately depressed group. Data on psychological problems among children with diabetes showed that 57.3% experienced emotional symptoms, conduct problems were close to the average among 66%. Data on psychological problems among parents of children with diabetes showed that 45.3% of parents did not experience depression; 22.7% belonged to the moderately depressed group. Psychosocial problems were common both among children and parents. More research is needed in the context of caring for a child with chronic diseases and the role of health care providers in adapting and mitigating psychological problems among both parents and children.

Study design: Systematic literature review of case-controlled studies.Introduction: Carpal tunnel syndrome (CTS) is one of the most common tubular neuropathies where certain anatomical variations may be accounted for as risk factors for CTS, including body mass index (BMI), wrist ratio (WR), wrist to palm ratio (WPR), shape index (SI), and digit length.Purpose of the Study: To assess case-control studies examining the association between specific anatomical variations of the wrist as risk factors for developing CTS and whether this effect is the same for both genders.Methods: The literature search was conducted between February-June 2020 through PubMed, Cochrane Library, CINAHL Plus and PEDro. The literature search yielded 149 potential publications, fifteen of which were filtered in accordance with eligibility criteria. The methodological quality was assessed by using the Newcastle-Ottawa Quality Assessment Form for Case-Control Studies (NOS).Results: The total number of subjects included in this review was n=4299. The largest sample was n=1117 participants and the smallest n=54. All studies included patients who had a clinical diagnosis of CTS confirmed with nerve conduction studies and or ultrasonography. CTS was significantly higher in patients with higher BMI, WR, WPR compared to control groups. BMI and WR were the only indicators that can be considered as strong risk factors.Conclusions: Discussion: Despite the general patterns on the association of BMI, WPR, WR and SI as risk factors for the development of CTS, there were exceptions to the accepted results and conclusions. Conclusion: Clinicians are recommended to conduct more research to confirm anthropometric measurements as risk factors for the development of CTS, mainly SI and WPR. When determining the cut-off values for BMI and WR, it is recommended to take into account additional risk factors such as occupation.

BackgroundWorldwide, most of educational institutions have moved to online electronic learning methods because of the COVID-19 pandemic. On March 8, 2020, the Saudi Ministry of Education announced remote learning for public and private schools and universities as a preventive and precautionary measure to curb the spread of the coronavirus. The objective of this study was to explore the e-learning experience of the students of the colleges of health sciences with regard to the technical preparedness, academic achievements, e-learning advantages and limitations. A well-structured and validated questionnaire on a five-point Likert scale and open-ended questions about their e-learning experience was distributed to a heterogeneous purposive sample of the health sciences students in Saudi Arabian universities.ResultsOf the 1288 respondents, of various demographical features a relatively higher proportion of 58.2 % agreed that they had enough information about the online learning. However, the proportion who reported receiving adequate guidance, technical support, and having satisfactory hardware and internet access to online learning were 48.1 %, 42, and 35.4 %, respectively. Of all participants, 40.8 % agreed that they had gained a good understanding of their courses learning outcomes. Only 30.0 % agreed that the quality of the online teaching was similar to traditional classes and 56.1 % agreed that the online learning is unsuitable for the medical sciences studies.E-learning advantages mentioned were the flexible accessibility of the learning materials, time, effort, and money saving, acquiring and improving technical and self-learning skills, health safety, interaction without shyness, and better academic accomplishment. On the other hand, disadvantages and difficulties included inadequate tools to facilitate online learning, poor internet connection, lack of technological skills by the educators and students. In addition, there was inadequate or lack of practical classes, lack of a unified clear policy for the conduct of online classes and exams and grade distribution, limited online exam time.ConclusionsThe sudden shift to e-learning without prior preparedness has revealed some pitfalls that need to be adjusted. The initial findings were considered satisfactory for such a new experience for both learners and students. However, there is a great chance for improving and expanding the e-learning process.

The quality assurance (QA) of ultrasound transducers is often identified as an area requiring continuous development in terms of the tools available to users. Periodic evaluation of the transducers as part of the QA protocol is important, since the quality of the diagnostics. Some of the key criteria determining the process of developing a QA protocol include the complexity of setup, the time required, accuracy, and potential automation to achieve scale. For the current study, a total of eight different ultrasound machines (12 transducers) with linear transducers were obtained separately. The results from these 12 transducers were used to validate the protocol. WAD-QC was used as part of this study to assess in-air reverberation patterns obtained from ultrasound transducers. Initially, three in-air reverberation images obtained from normal transducers and three obtained from defective transducers were used to calculate the uniformity parameters. The results were applied to 12 other images obtained from independent sources. Image processing results with WAD-QC were verified with imageJ. A comparison of raw data for uniformity showed consistency, and using controls based on mean absolute deviation yielded identical results. WAD-QC can be considered as a powerful mechanism for quick, efficient, and accurate analysis of in-air reverberation patterns obtained from ultrasound transducers.

Background: Although MAIT cells regulate the pathogenesis of various inflammatory diseases, their roles in the development of colorectal cancer are still unclear. The objectives of this study is to investigate the level of circulating MAIT cells and the level of expression of the membranous KIRs receptors among CRC patients and control subjects. Peripheral blood mononuclear cells (PBMCs) were isolate and of MAIT cells were phenotypically identified by flow cytometry using various monoclonal antibodies. The presence of HLA-C1 and HLA-C2 groups were typed by PCR. Results: The percentage of MAIT cells were higher in CRC patients compared to control subjects. The percentage of MAIT cells was higher in patients with CRC in stage III and IV, but lower in stage II compared with control subjects. High frequency of HLA - C2 among patients with CRC (87%) compared with control subjects (74.4%). The protein expression of MAIT cells associated phenotyping antigens and some KIR receptors such as CD45RA, CD45RO, CD62L, CD11a, CD158a, CD158b, CD158e and CD158f were reported. A relatively lower percentage of CD45RA expression was seen in CRC patients compared with control subjects. There was a significant reduction in CD45RO, CD62L, CD158a, CD158e and CD158f expression in CRC patients. Stratification analysis of 46 CRC patients indicated that the percentages of circulating MAIT cells were lower in stage II and higher in stages III, and IV. The frequencies of circulating MAIT cells had not been reduced in patients with colorectal cancer.Conclusions: The number and level of circulating MAIT cells were evaluated in peripheral blood of CRC patients and control subjects. We compared the frequency of CD158a+MAIT cells in all stages of CRC and control subjects in the presence of its ligand HLA-C2 and found a significantly reduction in all stages of CRC. We stratified CRC patients and found that CD158b+ MAIT cells were decreased as the diseases progress to advancing cancer stages. When comparing the proportion of CD158a and b+ MAIT cells in all stages with control subjects, the results showed inverse correlation with cancer stages in CRC patients and the median gradually decrease in each stage.

Cancer is the second leading cause of death worldwide. Breast cancer, the most common cancer found in women, affects 2.1 million women annually and has the highest number of cancer related deaths. The objective of the current meta-analysis is to evaluate the effects of post-diagnosis exercises on depression, physical functioning, and mortality in breast cancer survivors.The search for eligible articles was conducted through CINAHL, Medline/PubMed, Scopus, Cochrane, Emerald Insight and Web of Science, Embase database, MEDLINE In-Process, Elsevier, Google Scholar, PsycInfo, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Allied and Complementary Medicine (AMED), Biosis Previews, SPORTDiscus, PEDro scientific databases from 1974 to 2020. Following the exclusion procedure, 26 articles yielded for final analysis. The combined statistics for depression, physical functioning, and mortality in breast cancer survivors were calculated using standardized mean differences (SMD). Standard errors and 95% confidence intervals (CI) were converted to standard deviations as required. For mortality, combined statistics were calculated using hazard ratios (HR). The 95% CIs were converted to standard errors as required. The forest plots display point estimates and 95% CIs.Statistically significant improvements on levels of depression were identified following the exercise intervention, suggesting that post-diagnosis physical activity leads to a decrease in depression scores. Overall, post-diagnosis exercise led to a 37% reduction in the rate of breast cancer-specific mortality. The all-cause mortality rate was decreased by 39% with the inclusion of moderate physical activity as the part of daily routine.Future studies should look at how to improve the quality of life while incorporating physical activity as a daily routine after breast-cancer treatment.

Factor XII deficiency is a rare autosomal recessive health condition usually discovered incidentally during routine coagulation screening before surgery after investigating a prolongation of the activated partial thromboplastin time. This is a case of a 29-year-old man from Saudi Arabia who was selectively admitted to the surgical department to treat a perianal fistula and found incidentally prolonged activated partial thromboplastin time and factor XII deficiency. Examination of the skin revealed no bruising, petechiae, or ecchymosis. Systemic examination was normal. Laboratory examination showed an activated partial thromboplastin time > 160 s (normal between 27 and 38), which was repeated twice with low factor XII

AstraZeneca vaccine became one of the four vaccines that encode different forms of the SARS-CoV-2 spike glycoprotein. We report the case of an 18-year-old medically free female with progressive bruising of the upper and lower extremities for 1 week, beginning 3 days after the first dose of AstraZeneca. Laboratory results showed severe thrombocytopenia of 4.3 × 103/µL with a normal white blood cell count, renal profile, and hemolytic markers. She was treated conservatively with high-dose steroids and intravenous immunoglobulin, which resulted in a full recovery of her platelet count. In our case, the question was raised about the possibility of receiving a second dose of another vaccine product instead of not being vaccinated again, a subject for further research.

Factor X deficiency is one of the rarest coagulation disorders representing 10% of all rare bleeding diseases with a frequency of 1:1,000,000. A 39-year-old male patient with no previous medical conditions was admitted to the hospital with a left carpal ganglion for surgical excision. Routine preoperative laboratory examination revealed a high international normalized ratio of 5.4 IU (0.8–1.1) and a prothrombin time of 72.2 s (10.9–13.6), with an isolated factor X level of less than 5%. Genetic testing for congenital factor X deficiency identified a homozygous mutation c.271 > A (p.Glu91). Vitamin K supplementation did not improve his international normalized ratio or increase factor X levels; hence, surgery was delayed. The patient was re-hospitalized to remove a wisdom tooth, during which fresh frozen plasma was administered. An allergic reaction complicated this procedure in the form of a rash on the body. As a result, the tooth was removed without active bleeding. This report presents a unique factor X deficiency case with limited treatment options to improve factor X levels after failed vitamin K administration and an allergic reaction to fresh frozen plasma. A physician’s observation and ongoing follow-up were the only reasonable approaches in treating the patient with mild to moderate factor X deficiency due to lack of prothrombin complex concentrates or factor X replacement at the center at the time.

Objective/background Mutations in transmembrane protease serine 6 (TMPRSS6) gene induce high hepcidin level, which causes iron-refractory iron deficiency anemia (IRIDA) by preventing duodenal iron absorption. This study aims to identify the common genetic variations of the TMPRSS6 gene that affect iron levels among Saudi female patients with iron deficiency anemia (IDA). Methods All study participants were Saudi females (12–49 years old): 32 patients with IDA, 32 patients with IRIDA, and 34 healthy individuals comprising the control group. Hematological investigations, iron profile, serum hepcidin level, and TMPRSS6 gene transcription were determined. The TMPRSS6 gene was amplified, sequenced, and analyzed among all study participants. Results The mean hepcidin and TMPRSS6 RNA transcription levels in IDA and IRIDA groups were significantly lower than those in the control group. TMPRSS6 gene sequence analysis detected 41 variants: two in the 5′ untranslated region (5′UTR), 17 in introns, and 22 in exons. Thirty-three variants were previously reported in the Single Nucleotide Polymorphism Database, and eight variants were novel; one novel variant was in 5′UTR (g.-2 T > G); five novel variants were detected in exons (p.W73X, p.D479N, p.E523K, p.L674L, and p.I799I). At the time of the sequence analysis of our samples, two variants—p.D479N and p.674L—were novel. However, these variants are present at a very low allele frequency in other populations (L674L, 0.00007761 and D479N, 0.000003980). Conclusion This is the first study to investigate the genetic variants of TMPRSS6 gene in Saudi female patients with IDA. The generated data will serve as a reference for future studies on IDA in the Arab population.

Rapid economic growth, improved living standards, and immense urbanization in the Kingdom of Saudi Arabia (KSA) have affected nutritional habits and physical activity. Recent increases in physical inactivity, sedentary behaviours, consumption of caloric-dense diets, and sugar-sweetened beverages have led to overweight and obesity and non-communicable diseases (NCDs). This study's objectives are to 1) determine current prevalence of and risk factors for obesity, and 2) predict the probability of obesity among full-time employees of Sadara, the largest chemical company in KSA. In 2019, a written survey in both Arabic and English was administered to 505 Sadara employees randomly selected from five Sadara locations. A number of factors possibly associated with BMI were examined using Chi-Square test: age, physical activity, screen watching, childhood region, nationality, fat intake, sugar intake, family size, household income, and consumption of meal-replacement bars. Logistic regression was performed to compare the trends and predict conditional probabilities of obesity. The sample was 92% male, 61% Saudi, from the Eastern Province of KSA, with a mean age of 34 years. Employees aged 30–39 years were found to have 1.8 times greater odds for obesity than the youngest employees (below 30 years). More specifically, those aged 30–39, who grew up in the Eastern Province, who had low physical activity and long periods of watching electronic screens had the highest probability of obesity (more than 66%). Workplace wellness programs that focus on lifestyle habits could help reduce the high prevalence of overweight and obesity and associated NCDs in KSA.

The purpose of this primary data analysis is to estimate the prevalence of obesity in a specific workplace in the Kingdom of Saudi Arabia (KSA). The information would then be used to predict the prevalence of obesity among the male workforce of Saudi Aramco, the largest oil company in the world. A total of N=1,000 male employees (883Saudis, 117non-Saudis), aged 19-65, participated. They were randomly selected from several male Saudi Aramco stations and were asked to take a survey. Chi-square test was used to measure the significance effect of some independent variables on the BMI status. The overall prevalence was estimated, with a confidence level of 95%, at 22.5±2.6% for obesity, 36.7±3% for overweight, and 1±0.6% for underweight. The figures highly depended on the region where they spent their childhood, their age, nationality, and amount of exercise performed per week. For instance, 27.4±4.2% of those who grew up in the Eastern Province were estimated to be obese (vs. 16.5±3.5% among those raised elsewhere in KSA), and 28.7±5% of those who rarely exercise (less than 1 hour per week) were considered obese (vs. 17.8±4.1% among those who work out for at least 3 hours per week). As a result, a logistic model, involving these factors, was used for future prediction. For example, non-Saudis would be about 2.3 times more likely to be obese, and those aged 30-39 would be about 1.9 times more likely to be obese compared to “under 30” and “50 or more” age groups and 1.7 times more likely to be so than those aged 40-49. In addition, the lowest and highest conditional probabilities of obesity relative to this model were determined (6.6% and 66.4%). As a result, the likeliest male employees to be obese; the non-Saudi ones, raised in the Easter Province, aged 30-39 and exercise very little (less than 1h/w), would actually have more than two chances in three to be obese. Based on relatively concerning figures about obesity in male employees of Saudi Aramco, this paper recommends workplace wellness program model to improve the health of employees and their productivity, by creating an atmosphere of health and care for their well-being.