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Aim: This systematic review and meta-analysis aimed to evaluate the safety and efficacy of combined laser and anti-VEGF therapy for (retinopathy of prematurity ROP), focusing on both structural and functional outcomes., Methods: A comprehensive search was conducted in multiple databases to identify randomized controlled trials (RCTs) that investigated combination therapy for ROP. The PRISMA guidelines were followed. Data were extracted and analyzed using risk ratios and 95% confidence intervals (CIs). The Cochrane Risk of Bias tool was used to assess the risk of bias., Results: Three RCTs involving a total of 162 premature infants were included in the meta-analysis. Combination therapy of anti-VEGF and laser photocoagulation was compared with other interventions. The pooled analysis of favorable structural outcomes did not show a statistically significant difference between combination therapy with anti-VEGFs and laser therapy compared to the interventions in the control groups (P=0.25). The incidence of adverse events was comparable between the combination therapy group and other intervention groups., Conclusion: This systematic review and meta-analysis suggest that risk ratio of combination therapy with anti-VEGF and laser for ROP is associated with favorable outcomes, albeit insignificant. The safety profile of combination therapy appears to be similar to other interventions. However, due to the limited number of included studies, further research is needed., Competing Interests: The authors report no conflicts of interest in this work., (© 2025 Alamoudi et al.)

Purpose: Oral isotretinoin is a derivative of vitamin A, used to treat acne vulgaris. One of its effects is altering the corneal surface and ocular glands, resulting in eye dryness and various other symptoms. This study aimed to analyze the impact of systemic isotretinoin treatment on ocular health and investigate the potential risk factors contributing to ocular pathology., Patients and Methods: This cross-sectional study was conducted on 489 participants in the Jazan region using a convenience sampling method. An online questionnaire composed of five sections, including the Arabic version of the validated Ocular Surface Disease Index (OSDI), was used to assess the presence of ocular symptoms associated with isotretinoin usage as well as the potential contributing risk factors., Results: A significant association was established between oral isotretinoin use and specific eye symptoms, including a gritty feeling in the eye (66.4%), sore eyes (68.6%), blurry vision (75.9%), and the need for moisturizing drops (35%). OSDI severity varied according to isotretinoin usage status, with severe OSDI grades reported in 56.9% of current users, 51.2% of those who stopped < 2 months ago, and 38.8% of those who stopped ≥ 2 months ago. Furthermore, significant risk factors associated with worse OSDI grades included contact lens use and isotretinoin dose, with contact lens use being associated with a 17.5-point increase in OSDI scores, while each 10 mg increase in isotretinoin dose was linked to a 0.20-point rise in OSDI score., Conclusion: This study emphasizes the importance of assessing individual risk factors before starting isotretinoin therapy and monitoring ocular health in patients undergoing therapy. Clinicians should be aware of preventive methods and should consider high-risk patients to an ophthalmologist for interventions, such as punctal plugs, that can reduce complications. Further research targeting specific populations with shared risk factors is needed to validate these findings., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Abuallut et al.)

Purpose: Cognitive flexibility is a mental ability that aids in smoothly alternating between them tasks in the brain. Diabetes Mellitus (DM) is a, common disorder that has been associated with impairments in cognitive functions. This research is a retrospective case-control study aimed at establishing a clear relationship between cognitive flexibility and diabetes among Jordanians, considering demographic, anthropometric, and therapeutic variables., Patients and Methods: The Wisconsin Card Sorting Test (WCST)-64 item and the Trail Making Test (TMT) assessed cognitive flexibility in 268 people with diabetes and healthy control. Demographic, therapeutic data were collected. We also measured waist-to-hip ratio (WHR) and body mass index (BMI). As the variables were non-normally distributed, non-parametric statistical tests were used to examine differences (Kruskal-Wallis) and correlation (Spearman) between variables., Results: The patient group did worse on the WCST In contrast to the control group, patients exhibited more significant delays for both Part A and Part B of the TMT (p<0.05). Males had higher WCST conceptual level responses than females. In addition, participants with professional jobs showed less delay in TMT Part A (p<0.05). Age was positively correlated with WCST's total errors and TMT's Parts A and B (p<0.05). BMI was negatively correlated with the WCST's conceptual level of responses and positively correlated with TMT's Part B (p<0.05). In addition, urea and albumin levels were positively correlated with TMT's Part A (p<0.05). Furthermore, creatinine was positively correlated with WCST's total errors and TMT's Part A (p<0.05)., Conclusion: Some measures of cognitive flexibility are associated with DM status in the studied sample of Jordanians and other variables (educational levels, occupation, lifestyle, average duration of illness, and age)., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Amin et al.)

Purpose: Artificial Intelligence is drastically used nowadays in healthcare, but little is known about the attitude and perception of medical students towards AI in Saudi Arabia. This study aimed to explore undergraduate medical student's views on AI, assessed their understanding of AI, and the level of confidence of using basic AI tools in the future., Methods: This cross-sectional study invited 303 medical undergraduate students to complete an anonymous electronic survey, which consists of questions related to attitude, understanding and confidence of using basic AI tools. We examined the statistical association between the categorical variables by using Chi-square test., Results: The results of the study indicate that eighty-seven percent of participants believed that AI will play significant role in healthcare. Thirty-eight percent respondents reported that they have an understanding of the basic computational principle of AI. 71.29% respondents agreed that teaching in AI would be favorable for their career. More than half of the participants were confident in using basic AI tools in the future, Male students ( p = 0.00), 26-30 years old participants ( p = 0.03), intern students ( p = 0.00), and Imam Abdulrahman Bin Faisal University medical students ( p = 0.04) had positive attitude of artificial intelligence. Male participants ( p = 0.02), and intern students ( p = 0.00) had the highest proportion of confidence in using basic healthcare AI tool. Nearly 14% students received training on AI. Participants who received training on AI reported better understanding of AI ( p = 0.03), develops positive attitude towards teaching in AI ( p = 0.05), more confidence in using basic healthcare AI tools ( p = 0.05)., Conclusion: Saudi medical undergraduate students understand the significance of AI and demonstrated a positive attitude towards AI. Medical students training on AI should be expanded and improved to avoid threats for seeking jobs by adapting artificial intelligence., Competing Interests: The authors declare no conflicts of interest in this work., (© 2024 Alwadani et al.)

Introduction: Gastroesophageal reflux disease (GERD) and functional constipation (FC) are two common gastrointestinal disorders that affect many age groups in the community. A few studies were conducted to find the association between GERD and FC, but no study had been conducted in Saudi Arabia. Therefore, this study aims to find the overlap between GERD and FC and associated risk factors among the general population in the Eastern Province, Saudi Arabia., Methods: A cross-sectional study was conducted in the eastern province of Saudi Arabia between August and September 2022. GERDQ and Rome IV criteria were used to collect the data with participants' characteristics through an online questionnaire., Results: Out of 2007 respondents, 1481 filled the required criteria, among them 320 (21.6%) had GERD, and 1292 (87.2%) respondents had FC based on the listed criteria. Eighty percent of respondents with GERD had overlapping FC. Men were more likely than women to experience this significant relationship (53.1% versus 46.9%)., Conclusion: There is a significant relationship between GERD and FC among the general population of the eastern province of Saudi Arabia. Consequently, this study could be used to improve the understanding of the overlapping between these gastrointestinal disorders and further new guidelines could be carried out to find the best treatment for these patients., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Al Jalal et al.)

Background: Coffee consumption by young people has increased dramatically over the last decades as there are substantial evidence of the physiological, cognitive, and emotional effects of coffee consumption. To reduce the risk of consuming related harm, it is necessary to understand the consumer's motivation for its use., Objective: This study aimed to investigate coffee consumption behavior in young adults, assess the type of coffee consumption, explore motivation, document adverse effects and withdrawal symptoms of coffee intake., Methods: A sample of 923 young adults were recruited voluntarily to complete a set of measures examining motivations, adverse effects, and withdrawal symptoms of coffee intake. Logistic regression analysis was performed to determine the association between coffee consumption and all independent variables. A p -value of 0.005 was considered as statistically significant., Results: The results indicate that more than half of the participants consumed coffee. Coffee consumers were more like to be male, young adults, unmarried, poor sleep pattern (3-5 hours), and smokers. Main motivations of coffee intake were those related to reinforcing effects. The prevalence of dripper coffee consumption (85.59%) was observed to be highest with 20.1% participants consuming coffee in 2-3 times per day. Participants experienced restlessness, shaky, excited, difficulty in falling sleep, and fast heart beat as adverse effects of coffee consumption. Withdrawal symptoms such as headache, mood change, and tiredness were also noticed after consuming a high amount of coffee. Gender ( p < 0.005), age ( p < 0.003), family income ( p < 0.004), BMI ( p < 0.002) and sleeping pattern ( p < 0.005) were found important variables associated with coffee intake., Conclusion: The association reported in this study may allow for the implementation of appropriate strategies to address behaviors towards excessive coffee consumption and its link to an increased risk of poor health., Competing Interests: The authors declare no conflicts of interest in this work., (© 2023 Lone et al.)

Background: Medical education is a challenging profession requiring students to acquire various skills and develop them continuously before and after graduation. The study aimed to assess the students' preference toward specialty and determine their preferred residency program and future ambitions regarding administrative and leadership positions., Methodology: This is a cross-sectional self-administered survey that included medical students in 1st year, and 5th year and internship at Imam Mohammad Ibn Saud Islamic University (IMSIU). The questionnaire consisted of demographic information and questions about the student's choices regarding plans., Results: Four hundred and fifty-eight (458) medical students out of 583 students (55.5% junior and 44.5% senior students) enrolled themselves in the study and completed the survey. Findings revealed that medical students' top five preferred future general medical specialties were surgery (34.5), followed by internal medicine (18.3), family medicine (17.2), dermatology (14.6), and emergency medicine (15.9). The junior students were found to be more inclined toward dermatology, medical genetics, and surgical general specialties. The findings showed that 63% of the students were interested in becoming future leaders, with 52.8% of them wishing to become head of a medical department. When asked about their desired qualifications, 85.8% preferred the Saudi Board., Conclusion: Surgery was the most favorable specialty among medical students, followed by internal medicine, family medicine and dermatology, and emergency medicine. The study showed a significant difference between males and females and seniors and juniors in preference of specialty and medical qualification, the female medical students prefer to specialize in dermatology (p=0.027), neurology (p=0.028), and obstetrics and gynecology (p=0.001) as a general specialty significantly more than male medical students. It shows that students are interested in future leadership goals., Competing Interests: The authors declare no conflicts of interest in relation to this work and that there is no conflict of interest regarding the publication of this paper., (© 2022 Bin Abdulrahman et al.)

Background: Urinary tract infections (UTIs) are the most prevalent infections, with a variety of etiologic agents, a high number of occurrences, relapses, and complications; also, antibiotic resistance of the pathogenic bacterium is a hugely significant challenge for physicians., Objective: The goal of this research was to identify the common bacterial uropathogens as well as their susceptibility to commonly used antibiotics., Materials and Methods: During the first six months of 2018, a descriptive cross-sectional study was conducted on urine samples of 1780 patients at FMIC based on culture. Bacterial typing was performed using cystine lactose electrolyte deficient agar and blood agar, and Kirby-Bauer disc diffusion was employed to assess the sensitivity of the bacteria to various antibiotics., Results: Among 1780 patients in 341 (19.15%) samples, uropathogens were isolated. E. coli (63.9%), Enterococcus (11.1%), Serratia species (10.8%), Staphylococcus species (8.2%), Klebsiella (2.9%), Proteus species (1.8%), and Pseudomonas aeruginosa (1.2%) were the most common bacterial uropathogens. More than two-thirds of patients were female (69.6%), with the remaining 30.4% male. Ampicillin, amoxicillin, and erythromycin were the antibiotics with the highest resistance rates in bacterial uropathogens, at 92.6%, 82.9%, and 82.1%, respectively. Furthermore, ceftriaxone, ceftazidime, cefixime, and sulfamethoxazole were antibiotics with resistance rates exceeding 70%. The antibiotics pristinamycin and ticarcillin were the most sensitive, with a TRR of zero. Ertapenem, imipenem, amikacin, tazobactam, fosfomycin, vancomycin, and nitrofurantoin were the antibiotics with the lowest resistance rates (less than 10%)., Conclusion: E. coli was the most common bacterial uropathogen isolated in this study, followed by Enterococcus species. Our findings suggest that physicians, particularly in FMIC, consider E. coli , Enterococcus , Serratia and Staphylococcus as the most common bacteria, and use pristinamycin, ticarcillin, ertapenem, imipenem, amikacin, tazobactam, fosfomycin, vancomycin, and nitrofurantoin as sensitive antibiotics in empirical UTI treatment., Competing Interests: The authors report no conflicts of interest in relation to this work., (© 2022 Joya et al.)

Due to the absence of successful therapy, vaccines for protection are continuously being developed. Since vaccines must be thoroughly tested, viral respiratory tract infections (VRTIs), mainly coronaviruses, have seriously affected human health worldwide in recent years. In this review, we presented the relevant data which originated from trusted publishers regarding the practical benefits of functional foods (FFs) and their dietary sources, in addition to natural plant products, in viral respiratory and COVID-19 prevention and immune-boosting activities. As a result, FFs were confirmed to be functionally active ingredients for preventing COVID-19 and VRTIs. Furthermore, the antiviral activity and immunological effects of FFs against VRTIs and COVID-19 and their potential main mechanisms of action are also being reviewed. Therefore, to prevent COVID-19 and VRTIs, it is critical to identify controlling the activities and immune-enhancing functional food constituents as early as possible. We further aimed to summarize functional food constituents as a dietary supplement that aids in immune system boosting and may effectively reduce VRTIs and COVID-19 and promote therapeutic efficacy., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Omer et al.)

Background: Psoriasis is a common skin disease that affects physical, psychological, and social well-being of patients. Several studies have assessed health-related quality of life of patients with psoriasis in different populations with large variations., Objective: To investigate, for the first time, the impact of psoriasis on quality of life of Afghan patients with psoriasis., Methods: This is a prospective observational study conducted at the dermatology department of Maiwand Teaching hospital in Kabul City during April 2018 to May 2019. Patients with plaque psoriasis with age ≥16 years were included in the study. Psoriasis Disability Index was used for the assessment of health-related quality of life. Psoriasis Area and Severity Index was used to define the severity of disease. Appropriate tests were performed using Statistical Package for Social Science., Results: A total of 174 patients with psoriasis were included in the study, 89 of them were male (51.1%) and 85 of them were female (48.9%). The mean age of the patients was 27.7 years with 13.2 years SD, and the average duration of the disease was 3.2 years with 4.7 years SD. The mean of PASI score was 13.3 with 7.8 SD, while the mean of total PDI was 9.6 with 3.7 SD; there was a strong correlation between total PDI and PASI score ( r =0.751, p<0.001). The mean of total PDI was higher among moderate-to-severe psoriasis, female patients, younger age, and those who were single., Conclusion: Our study highlighted that psoriasis disability index was highly correlated with psoriasis area and severity index. Furthermore, the quality of life was more affected among female patients, patients younger than 40 years, and those patients who were single., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Aalemi et al.)

Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to excess hormones and is also one of the life-threatening iatrogenic complications which is associated with ovulation induction. This syndrome usually occurs in women who receive injectable hormones for the stimulation of egg development in the ovaries. This study describes a rare case of moderate ovarian hyperstimulation syndrome which has been managed and treated with high-dose cabergoline. The patient was diagnosed in the Medical Imaging and Radiation Sciences Department of Kabul University of Medical Sciences and treated in Shahrara Teaching Hospital. A 26-year-old woman was diagnosed with the development of bilateral moderate ovarian hyperstimulation syndrome after receiving clomiphene citrate in dose of 100 mg BID on day 5 of period and Human Chorionic Gonadotropin (HCG) 10,000 units for egg release on day 14 of period. The patient was given a high dose of cabergoline. The dose was adjusted to 1 mg/day for eight days since she was diagnosed with ovarian hyperstimulation syndrome. Consequently, the main outcome of our intervention was complete resolution of OHSS as well as complete recovery of the patient. As a result, it is concluded that the high dose of cabergoline prevents and reduces the occurrence, prolongation, and severity of ovarian hyperstimulation syndrome. However, more assessments through randomized controlled trials regarding the efficacy and safety of cabergoline doses and treatment duration for treatment and preventive purposes are required., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Manalai et al.)

Background: Psoriasis is a chronic inflammatory disease that is not limited to the skin. Recently, numerous studies have shown a positive association between metabolic syndrome and psoriasis., Objective: The current study aimed to examine the association of metabolic syndrome with psoriasis in an Afghan population., Methods: This was a case- control study including 114 patients with psoriasis and 114 controls aged ≥18 years admitted to the dermatology department of Maiwand Teaching Hospital in Kabul, Afghanistan. Height, weight, blood pressure, and waist circumference were measured in all subjects. Blood glucose, triglyceride, cholesterol, and high-density lipoprotein cholesterol levels were tested following overnight fasting. The modified National Cholesterol Education Program - Adult Treatment Panel III criteria were used for the diagnosis of metabolic syndrome., Results: In total, 51.8% of the cases and 44.7% of the controls were male. The average age of participants was 33.4±13.1 years in the case group and 41.1±15.4 years in the control group. The average duration of disease for psoriasis was 4.2 years with 5.6 years SD. The average PASI was 10.8 with 5.1 SD. More than half of the cases (62.3%) had moderate to severe psoriasis and 37.7% had mild psoriasis. The prevalence of metabolic syndrome was higher among patients with psoriasis compared to controls (36.8% vs 21.1%) with OR of 2.18 ( p =0.009). In addition, overweight/obesity was more prevalent among cases compared to controls (65.8% vs 41.2%) with OR of 2.74 ( p <0.001), whereas the waist circumference was not significantly different between the two groups. Furthermore, the mean levels of total cholesterol, triglyceride, and fasting blood glucose were also higher among patients with psoriasis compared to controls., Conclusion: The results of the study confirm the association between psoriasis and metabolic syndrome. Hence, screening psoriatic patients for metabolic syndrome should be considered., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Aalemi et al.)

Background: Previous observational studies suggest that the development of acne may be triggered by dairy intake., Objective: This study aimed to investigate the association of dairy intake and acne in Kabul citizens., Methods: From February to September 2018, 279 acne patients and 279 controls aged 10-24 years were enrolled in a case control study at the dermatologic outpatient department of Maiwand Teaching Hospital in Kabul City, Afghanistan. The acne severity was determined by a dermatologist using the Global Acne Severity Scale., Results: The consumption of whole milk 3 days or more per week was associated with moderate to severe acne (OR =2.36, 95% CI, 1.39-4.01). The association for low fat milk was less marked than for whole milk (OR 1.95 CI, 1.10-3.45). The risk was increased in those with a family history of acne in siblings (OR =4.13, 95% CI, 2.55-6.69). The risk was reduced in subjects doing physical exercise. No association with smoking emerged. A protective effect was associated with chicken consumption (OR =0.27, 95% CI, 0.15-0.49). Consumption of chocolate and chips was positively associated with acne., Conclusion: This study showed an association between high intakes of dairy products and acne in adolescence suggesting that dairy intake may be a factor contributing to acne., Competing Interests: The authors have no conflicts of interest to declare in this work.

General Objective: To evaluate the understanding and perceptions of generic medicines among final-year Doctor of Pharmacy students in Karachi, Pakistan., Methods: A 23-item survey instrument that included a question on the bioequivalence limits and Likert-type scale questions regarding the understanding and perceptions of generic medicines among the students was executed. Cronbach's alpha was found to be 0.62., Results: Responses were obtained from 236 final-year Doctor of Pharmacy students (n=85 from a publicly funded institute; n=151 from a privately funded institute). When comparing a brand-name medicine to a generic medicine, pharmacy students scored poorly on bioequivalence limits. More than 80% of the students incorrectly answered that all the products that are rated as generic equivalents are therapeutically equivalent to each other (P<0.04). Half of the students agreed that a generic medicine is bioequivalent to the brand-name medicine (P<0.001). With regard to quality, effectiveness, and safety, more than 75% of the students disagreed that generic medicines are of inferior quality and are less effective than brand-name medicines (P<0.001). More than 50% of the students disagreed that generic medicines produce more side effects than brand-name medicines (P<0.001)., Conclusion: The current study identified a positive perception toward generic medicines but also gaps in the understanding of generic medicines. Pharmacy students lacked a thorough understanding of the concepts of bioequivalence. Pharmacy academia should address these issues, which will help build confidence in generic medicines and increase the generic medicine use in Pakistan.