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Abstract Background The Arab Teens Lifestyle (ATLS) questionnaire was an initiative to assess the lifestyle habits influencing obesity rates in the Middle East and North Africa (MENA) region, including physical activity (PA) patterns, sedentary and eating behaviours. Since its implementation, the ATLS questionnaire has been used in several studies among different age groups and populations. This instrument has not previously been administered among the university students of the Eastern Province of Saudi Arabia, where the obesity rates are the highest in the country. This research was the first that aimed to identify lifestyle habits influencing the rates of obesity among 18-25-year-old university students in the Eastern Province of the Kingdom of Saudi Arabia (KSA) using the ATLS questionnaire. Methods Quantitative cross-sectional research among n = 426 students of the Eastern Province of Saudi Arabia using the ATLS questionnaire. Results Out of n = 426 participants, n = 200 (47%) were categorised (using body mass index) as normal weight; n = 113 (26.5%) were overweight, and n = 73 (17.1%) were obese. The findings showed that most of the nutritional, PA, and sedentary behavioural factors (e.g., screen time) in the questionnaire were not associated with obesity status amongst the participants. In the obese group, more of the males that consumed fruits, French fries, cakes, sweets and doughnuts more than three times per week were likely to be obese, which was not the case for females. Conclusion The reported lifestyles of the students could potentially lead to long-term negative health effects, which is of concern given the rising rates of overweight, obesity, and obesity-related non-communicable diseases (NCDs) among the Kingdom’s adult and ageing population. Further studies are recommended to explore the knowledge, attitudes, and perceptions of Saudi students in the Eastern Province in relation to PA, sedentary behaviours, and dietary habits, along with their views on how these can be improved.

BACKGROUND: Iron deficiency (ID) is considered a common health condition among military personnel, particularly soldiers during a period of high-intensity workouts. The causes, prevention, and treatment of ID anemia (IDA) remain the subject of ongoing and extensive research in various populations. AIM: This is the first research to study the outcome of 14 weeks of intensive physical exercise on the prevalence and factors associated with ID and IDA among Saudi military male trainees. MATERIALS AND METHODS: A cross-sectional study was conducted among n = 101 trainees who completed a questionnaire on sociodemographic data, dietary habits, current or past diagnoses of medical conditions, and physical activity. Two blood samples were collected from each participant to estimate (1) C-reactive protein and iron profile and (2) complete blood counts by the CellDYN Sapphire automated blood cell counter. Hemoglobin (Hb) fractions were identified and quantified by high-performance liquid chromatography using the TOSOH G8 analyzer to exclude hemoglobinopathy and thalassemia. RESULTS: The prevalence of ID, comprising both ID erythropoiesis and IDA among trainees, was found to be 65.3%. The occurrence of IDA was 5%, while ID erythropoiesis was detected among 60.4%. The prevalence of ID was statistically significantly higher among those drinking coffee during military training (P = 0.048). CONCLUSIONS: Further studies are recommended to validate this study’s findings by incorporating a larger sample and extending the duration of the training period and examine the mechanisms that explain the increased risk of ID during vigorous military training.

Essential thrombocythemia (ET) is a malignant hematological disease that has the ability to progress to acute leukemia or transform into other myeloproliferative neoplasms (MPNs). The coexistence of ET and other MPNs with pituitary adenoma (PA) is rare. There are no reports of cases of secretory PA of prolactin hormone in combination with ET. This case was reported in a young woman from Saudi Arabia who had the secretory PA present in combination with ET. The 20-year-old patient was treated for a micro-PA with hyperprolactinemia. The patient was referred to the hematological service for thrombocytosis. There was no history of thrombosis, cardiovascular risk factors, or constitutional symptoms. Laboratory tests showed that platelet levels consistently lagged from 700 × 103/µL to 1000 × 103/µL for 1 year. Hemoglobin 13 g/dL, white blood cells (WBCs) 6 × 103/µL, and normal WBC differential. The peripheral blood smear was inconclusive. A peripheral blood sample was sent for the cytogenetic study of myeloproliferative diseases, which came to be positive for c.1849G>T p.(V617F) mutation in the EXON 14 Janus kinase 2 (JAK2) gene. The patient was diagnosed with a MPN, ET with positive exon 14 JAK2, at low-risk category. Evidence suggests that MPNs in combination with endocrinological diseases are rare. However, there is a high incidence of MPN and unrelated tumors such as PA. Further research is recommended to thoroughly investigate endocrine tumors and look beyond secondary thrombocytosis that leads to thrombocythemia as in ET.

INTRODUCTION: Sickle cell disease (SCD) is an inherited autosomal recessive disorder with bone mineral density (BMD) as a common clinical manifestation of SCD. With a prevalence of 2.6%, Saudi Arabia is among the highest incidence of SCD worldwide. The purpose of this research was to examine how SCD evolves and how it affects bone density in Saudi patients from an Eastern Province tertiary hospital. METHODS: This was an observational prospective study conducted in the tertiary care hospital among 119 SCD patients. Patients were divided into two groups: Group A – severe SCD patients requiring hospital care ≥3/year; and Group B included patients with a smooth course of SCD who did not require frequent hospitalization (

[This corrects the article DOI: 10.1371/journal.pone.0285187.].

Background. A fixed drug eruption (FDE) is an immunological cutaneous adverse reaction, classified as a cutaneous adverse drug reaction (CADR) and characterized by well-defined lichenoid lesions that occur at the same site each time. Ceftriaxone is a third-generation antibiotic of cephalosporin antibiotics of the beta-lactam antibiotic family, which has typical in vitro activity against many Gram-negative aerobic bacteria. This is the first clinical case from Saudi Arabia and the fifth in the world to document a woman’s experience with recurrent FDE after repeated ceftriaxone use. Case Report. A 25-year-old Saudi woman with a known case of sickle cell anemia (SCA) with a history of avascular necrosis of the right hip after replacement was hospitalized with a pain crisis triggered by an upper respiratory tract infection. The patient denied having a history of allergy previously. Due to fever, leukocytosis, and active follicular tonsillitis, ceftriaxone was started. However, a few hours later she developed lip edema and a fixed drug eruption measuring 7 × 11 cm on the left side of her back. The lesion reformed over a hyperpigmented lesion (4 × 8 cm) that the patient did not report upon initial examination. It turned out that this was due to the intravenous administration of ceftriaxone, a year ago in another hospital. An allergy to ceftriaxone was considered, and steroids and antihistamines were started. The case was labeled as ceftriaxone induced FDE. Conclusion. Ceftriaxone induced FDE is an uncommon type of allergic reaction that has been reported infrequently. Understanding this condition and the mechanism by which FDE becomes recurrent with the same previous fixed lesion is of great importance for both academic and future research purposes.

Abstract Aim 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. Methods 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. Results 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. Conclusion 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.

Abstract 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.

Factor XI deficiency (FXI) is the third most common coagulation factor deficiency after hemophilia A and B, ie, in the hierarchy after factors VIII and IX, taking into account von Willebrand’s factor deficiency, as bleeding disorders are higher than in hemophilia C. Factor XII deficiency (FXII) is a congenital condition, inherited in the vast majority of cases in an autosomal recessive manner, more often associated with thromboembolic complications. A combination of both factor deficiencies has been found very rarely, and it can be familial multiple coagulation factor deficiency (FMCFD). This study reports the case of a 39-year-old woman from Saudi Arabia who had the combination of FXI and FXII deficiencies, known to be on treatment for hypothyroidism and was referred to a hematology clinic with an incidental finding of prolonged activated partial thromboplastin time (aPTT). Although there was no history of bleeding tendency, her siblings had a family history of an unknown type of bleeding disorder. On physical examination, the patient did not show any bruising, petechiae, or ecchymosis. The aPTT was 69 seconds (27-38) with normal use of other hemostatic agents and was corrected after a 50:50 mixing study. Intrinsic coagulation factors were evaluated, and they revealed severe FXI and moderate FXII deficiencies. Due to a strong family history, the patient was diagnosed with FMCFD. In conclusion, familial combined multiple clotting factor deficiency (FCMFD) is a rare condition that requires attention and reporting. The management strategy in such cases has not been well studied, especially in the long-term symptomatic patient with severe but asymptomatic combined FXI and FXII deficiencies, which is an area for review and further study.

Abstract 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.

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.

BACKGROUND: Thrombosis and acute respiratory failure are among the leading causes of mortality in COVID-19 patients. The von Willebrand factor (VWF) is one of the main components in the blood coagulation system. It has been hypothesized that the increased VWF level results from vascular damage because VWF is stored in endothelial cells. Infection of endothelial cells with SARS-CoV-2 can stimulate the release of VWF. This study aimed to determine the level of VWF activity among the Saudi population affected by COVID-19 and investigate the correlation between VWF level and D-dimer level. MATERIALS AND METHODS: This is an analytical, retrospective, observational study conducted in a single-center tertiary hospital at King Fahad Military Medical Complex (KFMMC). A study sample of 80 hospitalized patients (aged ≥18 years) diagnosed with COVID-19 confirmed by nasopharyngeal SARS-COV was randomly included in this study. Frozen blood samples were used to measure VWF antigen (Ag) level and activity for all patients. Historical data on hemostasis markers such as platelets (PLTS), fibrinogen, and D-dimer were obtained retrospectively, as well as demographic and clinical data. RESULTS: Data of 80 patients were analyzed to assess VWF Ag level and activity in correlation to D-dimer level. The mean age of the patients was 58.3 (standard deviation 16.18), with nearly two-thirds being females (62.6%). The most common comorbidities were arterial hypertension (67.5%), diabetes (56.3%), and dyslipidemia (22.5%). Only 10% of patients were obese. The mean values of were 3.25 for D-dimer, 3.55 for fibrinogen, 226.4 for PLTS, 9.88 for white blood cell, 237.04 for VWF Ag, 253.21 for VWF activity, and 70.45 for C-reactive protein. Pearson's correlation coefficient revealed that the correlation between D-dimer and VWF Ag and D-dimer and VWF activity was statistically insignificant (P > 0.05). Only six patients had overt thrombosis, but this has no significant correlation with VWF Ag, activity, D-dimer, or platelet count. VWF Ag and activity were higher in intensive care unit (ICU) than non-ICU patients. However, it is not significant statistically. VWF Ag and activity were significantly higher in deceased patients than in survivors. CONCLUSIONS: The results of this study showed that there was no significant correlation between VWF Ag and activity with D-dimer among Saudi patients with confirmed COVID-19.

There is compelling evidence for the psychological effects of the COVID-19 pandemic and earlier epidemics. However, fewer studies have examined the subjective meaning experience of healthcare providers who have survived COVID-19 as patients. This qualitative study aimed to understand further and describe the life experiences of healthcare providers who have survived COVID-19 as patients in Saudi Arabia. Data was collected using unstructured in-depth individual interviews among n = 10 healthcare providers from public hospitals in Saudi Arabia. Data were analyzed based on a phenomenological approach, which resulted in five themes: (i) physical and psychological signs and symptoms; (ii) self-healing, hiding pain, and family; (iii) fear of complications; (iv) disease stigma & long-term psychological outcomes; (v) emotional support, mental well-being & resignation. The overall synthesis showed that healthcare providers, as patients, experience the same difficulties and stressors as the general public. In some cases, these factors are even worse, as family members, colleagues, and employers develop a new type of stigma. Given the impact of social media and the flow of information of any type, more research is needed to examine the sources used to obtain information by the general public, whether these sources are reliable, and how the public can be taught to use only scientific data and not social data. Understanding the experience of healthcare providers as patients during the pandemic has allowed to look at the feelings and needs of people during illness from a new perspective. As expressed by participants, being a healthcare provider does not reduce the fear of the disease and does not mitigate its consequences in the form of stigmatization and isolation.

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

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.

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 × 10 3 /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.

Objective This systematic literature review aimed to study the relationship between CML and hearing loss. Database review Chronic myeloid leukemia (CML) is a hematological malignancy associated with high levels of white blood cells (WBCs). Changes in otolaryngology are observed in CML. Methodology This systematic literature review of the literature was conducted by searching the MEDLINE/PubMed, Scopus, WPRIM, LILAC Sand SciELO databases. Studies published between 2013 and 2023 that met inclusion criteria were included. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to evaluate the quality of studies. Results Of the 142 identified articles, 13 were included for final evaluation with a total sample size of 75 cases diagnosed with CML with hearing defect. CML patients with WBCs above 250 x 10 9/L were at higher risk of ototoxicity. Males accounted for 85% of cases; with a mean age of 38.9 years. Hearing loss as the first manifestation of CML was among 61.5% of cases, it was bilateral in 83.3% of cases, and in 90% of cases were irreversible defect. Conclusion Acute sudden hearing loss has been associated with high levels of WBC in patients with CML. Neither aggressive leukoreduction nor leukapheresis has positive effect on the reversibility of the hearing loss.