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aimel,1 Mohammed M Alshehri,4 Bader A Alqahtani,1 Faris A Alodaibi51Department of Health and Rehabilitation Sciences, College of Applied Medical Science, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; 2Department of Physical Rehabilitation, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 3Joint Clinic, Riyadh, Saudi Arabia; 4Physical Therapy Department, Jazan University, Jazan, Saudi Arabia; 5Department of Rehabilitation Science, King Saud University, Riyadh, Saudi Arabia Correspondence: Ahmed S Alhowimel, Department of Health and Rehabilitation Sciences, College of Applied Medical Science, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia, Tel +96611558888, Email a.a; [email protected] Purpose: This cross-sectional study aimed to validate the Arabic version of the Attitude toward Education and Advice for Low Back Pain (AxEL) Questionnaire. Patients and Methods: This study was conducted in two phases. First, the AxEL questionnaire was translated into Arabic and cross-culturally adapted. Second, the psychometric properties (such as validity) of the translated AxEL were evaluated. Results: The results showed that back translators and language specialists had no trouble translating the AxEL. The translators' agreement was very high (88.2%), and the questionnaire items were logically and clearly translated from English into Arabic. Conclusion: The Arabic version of AxEL is a valid tool that can assess individuals' beliefs and attitudes towards low back pain (LBP). It fills a significant void in cross-cultural research and can help healthcare providers understand the attitudes and beliefs influencing individuals' management of LBP within the Arabic context. [ABSTRACT FROM AUTHOR]

Background: SCD poses a significant healthcare burden. Understanding the factors contributing to high healthcare utilization and readmissions is crucial for improving the quality of care provided. Methods: This retrospective comparative observational study was conducted at King Saud University Medical City and included 160 SCD patients. A comparison was made between patients with no readmission and patients with at least one 30-day readmission. Another comparison was done between high healthcare-utilizing patients and low healthcare-utilizing patients. A regression model for 30-day readmission prediction was created. Results: Readmission was significantly higher in patients using opioids, following up with pain clinics, and having a history of AVN (p= 0.002, p=0.028 and p=0.025 respectively). Higher healthcare utilization was associated with older age, smoking, use of opioids and GABA analogs, and psychiatric illnesses, including depression, substance use disorder, and anxiety. Predictors of 30-day readmission were hydroxyurea use (odds ratio, 2.819 [95% CI,1.082 to 7.34], p = 0.034), follow-up with pain management clinics (odds ratio, 2.248 [95% CI,1.547 to 3.266], p = 0.001), and SCD genotype (SS genotype) (odds ratio, 1.754 [95% CI,1.012 to 3.042], p = 0.045). Using the Paracetamol/Codeine combination significantly reduced the likelihood of readmission within 30 days of discharge. Conclusion: This study identified factors associated with 30-day readmission rate and high healthcare utilization among SCD patients. Strategies to reduce readmissions may include specialized SCD clinics, educational programs for patients, improved physician awareness of mental health screening, and further research on the impact of opioid use. Limitations include retrospective nature, single-center design, reliance on self-reported data, and exclusion of critically ill patients. However, despite the limitations, this study could lay a foundation for future projects aiming to optimize care and outcomes for patients living with SCD. [ABSTRACT FROM AUTHOR]

aimah A Qadhi,2 Wajid Syed,3 Osama A Samarkandi,4 Mahmood Basil A Al-Rawi51Department of Community and Mental Health, College of Nursing, Riyadh, 11451, Saudi Arabia; 2Department of Medical-Surgical College of Nursing, King Saud University, Riyadh, 11451, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia; 4Department of Basic Sciences, Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, 11466, Saudi Arabia; 5Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Wajid Syed, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia, Email [email protected] Background and Aim: On the other hand, patient safety, is of the utmost importance, in addition to health care providers' counseling and advice, patient information leaflets (PILs) also have a significant impact on health outcomes. This study aimed to assess the Knowledge of medicine safety and Frequency of reading medication Leaflets and their predictors among the Saudi population in Riyadh Saudi Arabia.Methods and Materials: This cross-sectional study was conducted over three months in 2023 using online structured self-administered questionnaires, on the adults of Saudi Arabia, admitted to provide informed consent, aged ≥ 18 years, able to complete the questionnaires, being Saudi nationals, and currently living in the country. The data analysis was performed using the Statistical Package for Social Science (SPSS) version 27.Results: In this study, 23.6% (n=123) of respondents always read the PILs, while 14.6% (n=76) of them never read the PILs. In addition, 22.6% (n=118) of them find it difficult to understand the PILs. In this study, 53.9% of them revealed that ADRs are unexpected reactions after taking the normal dose and 15.4% of them do not know what ADRs are. The respondents gender (B= 0.164; SE=0.075; 95CI = 0.017– 0.310; p = 0.029), Social status (B = 0.251; SE = 0.079; 95CI = 0.096– 0.406; p = 0.002) and monthly income (B= 0.136; SE = 0.021; 95CI = 0.095– 0.178; p < 0.001) was the predictor of reading PILs.Conclusion: In this study, two-thirds of participants took medication and knew why they were taking it. However, only a few of them took the medicine after seeing a doctor, suggesting self-medication practice. In addition, 22.1% of them find it difficult to understand the PILS, and a small number of them would rather read it. Highlighting the significance of seeking medical advice from healthcare professionals before using a medication. [ABSTRACT FROM AUTHOR]

Introduction: Human papillomavirus (HPV) infection is a widespread sexually transmitted infection linked to various types of cancer. Although vaccination against HPV is available, global HPV vaccination rates remain low.Aim: This study aimed to evaluate the awareness and knowledge of the HPV vaccine and to identify predictors associated with vaccine hesitancy among health college students at King Saud University, Saudi Arabia.Methods: A cross-sectional survey was distributed during December 2022 to students enrolled in health colleges. The survey link was randomly distributed via social media platforms and in-person interactions. The number of participants was 405 including both males and females. The data was analyzed using the Statistical Package for Social Sciences (SPSS). The correct response rate for all knowledge items was calculated, and they were stratified by gender and college. The association of vaccine hesitancy with sociodemographic characteristics was examined using logistic regression analysis.Results: The study found that approximately half of the students (49.9%) were aware of the HPV vaccine. However, only a small percentage of students answered all to all HPV knowledge items correctly. Additionally, only a small proportion (5.2%) reported receiving the vaccine. The overall HPV vaccine hesitancy was 59.1% (43.9% for female and 75.9% for male). The most common reasons for vaccine hesitancy was not knowing enough about it. Males were two times more likely than females to believe that they did not need the HPV vaccine. The odds for HPV vaccine hesitancy were greater among males and younger age groups compared to females and older age groups.Conclusion: This study underscores the importance of implementing university-wide interventions and educational campaigns to enhance awareness and knowledge of the HPV vaccine. [ABSTRACT FROM AUTHOR]

aim,2 Saja H Almazrou21General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia; 2Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Saja H Almazrou, Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia, Email [email protected] Background: Chemotherapy safety guidelines have been enacted to minimize their side effects on healthcare providers when handling medications. The aim of this study is to assess the impact of an educational intervention on healthcare workers' compliance with chemotherapy safety guidelines.Methods: In this study, we used a quasi-experimental, pre-post testing design. It was conducted in the Oncology center at King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia. All healthcare workers involved in the preparation and administration of chemotherapy medications in KSUMC were invited. We evaluated Educational intervention to ensure the compliance of healthcare workers with standard safety guidelines through a questionnaire with 29 questions in total.Results: Fifty-two participants were eligible in this study. Overall, the score for mean compliance with workplace guidelines among the participants increased from 17.62∓0.78 to 18.17∓0.80 out of 19. Multiple liner regression indicates that there are no variables among the included variables predicting a change in post-intervention.Conclusion: This study indicates that educational intervention is the only effect of compliance in the included sample. Education safety training could improve healthcare workers' knowledge and consequently improve their compliance in the preparation and administration of chemotherapy medication. [ABSTRACT FROM AUTHOR]

Introduction:Helicobacter pylori infection is widespread and harmful, rendering its eradication a serious public health problem. Undergraduate students' general understanding of H. pylori infection is relatively poor. This was a second-phase research study to evaluate the efficacy of an educational intervention in raising awareness among university students.Methods: A quasi-experimental approach was employed, with 108 undergraduate students at King Saud University as participants. First, during the October 2021 academic year, data were gathered using a validated survey. The survey was divided into sociodemographic characteristics and H. pylori knowledge. Second, we assessed the effectiveness of an educational intervention to increase university students' awareness of the topic.Results: Before the intervention, the percentage of students that had good (9.3%), fair (28.7%) and poor (62%) knowledge of H. pylori infection changed to 55.6%, 41.7%, and 2.8% respectively. There was a significant increase in overall and domain-wise mean knowledge score after the educational intervention (p = 0.001). The pretest knowledge was independent of all socio-demographic variables except "whether or not they had heard about H. pylori infection" (χ 2= 8.666, p = 0.013).Conclusion: Educational intervention may help increase students' awareness of H. pylori infections. [ABSTRACT FROM AUTHOR]

aimi1,21Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Physical Therapy Department, Ministry of Health, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Maha Almarwani, Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Kingdom of Saudi Arabia, Tel +966 118058400, Email [email protected] Background: Adherence to home-based exercise programs can be improved by determining the factors associated with exercise adoption and maintenance in patients with multiple sclerosis. However, the factors that influence adherence to home-based exercise have been poorly studied among patients with multiple sclerosis in Saudi Arabia. This study aimed to examine predictors of adherence to home-based exercise programs among patients with multiple sclerosis in Saudi Arabia. Methods: This was a cross-sectional observational study. A total of forty individuals (mean age = 38.65 ± 8.16 years) diagnosed with multiple sclerosis participated in the study. Outcome measures were self-reported exercise adherence, the Arabic version of exercise self-efficacy, the Arabic version of patient-determined disease steps, and the Arabic version of the fatigue severity scale. All outcome measures were assessed at baseline, except for self-reported adherence to exercise, which was measured after 2 weeks. Results: Our results showed that the adherence to home-based exercise programs was significantly positively correlated with exercise self-efficacy and negatively correlated with fatigue and disability. Exercise self-efficacy (β = 0.62, p < 0.01) and fatigue (β = − 0.24, p = 0.04) were significant predictors of adherence to home-based exercise programs. Conclusion: These findings suggest that exercise self-efficacy and fatigue should be considered by physical therapists when designing a tailored exercise program for patients with multiple sclerosis. This may facilitate greater adherence to the home-based exercise programs and improve functional outcomes. [ABSTRACT FROM AUTHOR]

aimi,10 Arthur Isnani,3 Shaik S Nawaz,2 Khalid Alayed51Department of Internal Medicine, College of Medicine, and King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 2Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3Obesity Research Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 4Department of Medicine, College of Medicine, and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 5Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 6Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Infection Control Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 8Rheumatology Unit, Department of Internal Medicine, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 9Intensive Care Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 10Pediatric Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Assim A Alfadda, Department of Internal Medicine and the Obesity Research Center, College of Medicine, King Saud University, P.O. Box 2925(98), Riyadh, 11461, Saudi Arabia, Tel + 966 11 467 1315, Email [email protected] Background: The severe manifestation of coronavirus disease 2019 (COVID-19) is known to be mediated by several cytokines and chemokines. The study aimed to compare the early cytokine profile of mild and severe COVID-19 patients to that with COVID-19-like symptoms and tested negative for Severe Acute Respiratory Syndrome Coronavirus-2 in the Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) test. Methods: This was a prospective, observational study on COVID-19 patients admitted to King Khalid University Hospital, King Saud University Medical City from June to November 2020. Clinical and biochemical data were collected from hospital charts. Blood samples were collected at the time of hospital admission to measure cytokines. A Cytokine and Growth Factor High-Sensitivity Array was used to quantitatively measure cytokines. Results: The study included 202 RT-PCR-positive individuals and 61 RT-PCR-negative individuals. C-Reactive protein (CRP) and Interleukin-10 (IL-10) levels were found significantly elevated in the RT-PCR positive group compared to the RT-PCR negative group (p=0.001). Patients with severe COVID-19 had significantly longer median hospital stays than those with mild COVID-19 cases (7 vs 6 days). They also had higher CRP and Vascular Endothelial Growth Factor (VEGF) levels and lower Interleukin-4 (IL-4) levels compared to the mild cases. CRP, interleukin-6, IL-10, VEGF, and Monocyte Chemoattractant Protein-1 (MCP-1) levels were significantly elevated in men and IL-10 was significantly higher and interleukin-8 was significantly lower in women compared to negative controls. Elevated Interferon-ɣ (IFN-γ) and IL-10 levels were seen in mild COVID-19 cases and elevated level of MCP-1 was seen in severe COVID-19 cases when categorized according to the length of stay in the hospital. Conclusion: CRP and IL-10 levels were elevated in the RT-PCR positive group. People with severe COVID-19 had higher CRP and VEGF levels and lower IL-4 levels. Elevated IFN-γ and IL-10 levels were seen in mild COVID-19 cases and elevated level of MCP-1 was seen in severe COVID-19 cases when categorized according to the length of stay in the hospital. [ABSTRACT FROM AUTHOR]

aimah A Qadhi,2 Ahmed Al Sadoun,2 Wajid Syed,3 Mahmood Basil A Al-Rawi41Department of Nursing and Administration College of Nursing, King Saud University, Riyadh, Saudi Arabia; 2Department of Medical-Surgical, College of Nursing, King Saud University, Riyadh, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 4Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Wajid Syed, Email [email protected] Background: Physical activity (PA) is any prolonged movement produced by muscular tissues that cause the muscles to exert force. Despite its beneficial effect, it is frequently neglected by individuals. The present study aimed to determine the PA among young adults living in Saudi Arabia. Methods: This cross-sectional study was conducted among Saudi adults living in the Riyadh region of Saudi Arabia from June to August 2022 through a self-administered online survey. Global Physical Activity Questionnaire was used to assess the PA among participants. The data were analyzed using statistical software SPSS v. 26.0 (SPSS Inc., Chicago, IL, USA). Results: Among the surveyed adult males were the predominant 67.8% (n= 240). Most of them were young, aged between 24 to 34 years 62.4% (n=221), and 37.6% (n=133) of them were between 35 and 44 years old. The current findings reported that 63% (n=223) of the adults had PA on weekly basis. Walking 45.2% (n=160) followed by bodybuilding 12.7% (n=45) was the most common type of PA identified among adults. The barriers identified for not practicing PA were lack of time 46.9% (n=166). With regard to a sedentary lifestyle, it was reported that 9.55 (SD= 4.887) hours per day are spent sedentary or in a constant sitting. The adults gender (p=0.046) employment (p=0.0001) and educational status (p=0.0001) was significantly associated with the type of PA engaged. Although being a female were shown more sitting behavior than males (p< 0.047), similarly the nationality of the adults (6.67; SD=1.649) (p < 0.001), education (p=0.028) and monthly household income (p =0.024) were significantly associated with the overall mean sitting behavior. Conclusion: The findings of this study confirmed that Saudi adults yet posing highly sedentary behavior and physical inactivity, despite knowing the harmful outcomes of inactivity. Thus educating individuals about the importance of PA is warranted. [ABSTRACT FROM AUTHOR]

aim,5 Fatemah M Hakami,6 Ohud S Alsudyyes,6 Rahaf H Alsoghayer,6 Lina M Alhushan,6 Asma H Qudayr,6,7 Majed S Al Yami,2– 4 Omar A Almohammed6,81Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 2Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 4King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 5Pharmaceutical Care Division, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia; 6Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 7Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia; 8Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia*These authors contributed equally to this workCorrespondence: Ghazwa B Korayem, Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O.Box 84428, Riyadh, 11671, Saudi Arabia, Tel +966504161649, Email [email protected] Omar A Almohammed, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451, Saudi Arabia, Tel +966 555104065, Email [email protected] Background: Although parenteral anticoagulation lead-in is not recommended with apixaban and rivaroxaban, parenteral anticoagulation is often used to replace apixaban or rivaroxaban lead-in doses for the initial phase treatment of VTE. Thus, our study compares the safety and effectiveness of lead-in parenteral anticoagulation to lead-in apixaban or rivaroxaban in patients who received apixaban or rivaroxaban for VTE treatment. Methods: A multi-center retrospective cohort study included adult patients (aged ≥  18 years) admitted to the hospital with acute VTE and treated with either apixaban or rivaroxaban. Patients were grouped depending on the lead-in anticoagulation received for initial VTE treatment into the "Direct oral anticoagulation (DOAC) lead-in" group if patients received an appropriate lead-in dose of apixaban and rivaroxaban and patients who received parenteral lead-in the "parenteral lead-in" group. Results: A total of 389 patients were included; the DOAC lead-in group included 296 patients, whereas 93 patients were in the parenteral lead-in group. VTE recurrence (rVTE) during hospitalization and within 30 days was numerically higher in the parenteral lead-in group compared to the DOAC lead-in group (3.3% vs 0.6%; p=0.09 and 1.1% vs 0.7%; p=0.560), with a significantly higher number of patients with rVTE at 90 days (5.4% vs 1.4%; p=0.039). However, none of the patient's characteristics were significantly associated with the incidence of rVTE. In addition, the major bleeding rate during hospitalization was significantly higher among the parenteral lead-in group than in the DOAC lead-in group (14.0% vs 3.7%; p< 0.001). Conclusion: Parenteral anticoagulation lead-in before starting maintenance of apixaban and rivaroxaban showed a significantly higher risk of bleeding and a trend toward higher VTE recurrence than the DOAC lead-in. This study adds to the evidence supporting the utilization of the DOAC lead-in regimen in treating patients with VTE. Still, larger studies with robust designs are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

aiman Al Rajhi University, Qassim, Saudi ArabiaCorrespondence: Sahar Hasan Alsharif, Department of Dermatology, King Saud University, P.O. Box 24353, Riyadh, 11322, Saudi Arabia, Tel +00966555539141, Email [email protected] Background: Post-inflammatory hyperpigmentation (PIH) is skin hyperpigmentation that occurs due to any inflammatory condition. Triggering the melanocytes by inflammation leads to melanin overproduction and deposition. Tranexamic acid (TXA) is an antifibrinolytic medication prescribed to treat bleeding. Recently, there are some studies about the use of TXA in the treatment of PIH. Objective: The aim of this study is to identify the efficacy and the best mode of delivery for tranexamic acid in the treatment of PIH. Methods: This systematic review is reported in accordance with PRISMA guidance. We included all relevant English-language studies that were published up to September 2022 in the following electronic databases: Cochrane Library, PubMed, Embase, and Google Scholar. The initial search yielded 61 articles, 9 of which were included after applying inclusion and exclusion criteria. Results: The systematic review included a total of 196 patients who were over the age of 16 years old. Tranexamic acid was delivered orally in 4 studies, topically in 2 studies, and both simultaneously in 1 study. In addition, intradermal injection was used in 2 other studies. Almost all studies advocated the use of all routes for accelerating the clearance of hyperpigmentation with more favor towards topical and intradermal routes due to their mild reported side effects when compared to oral routes. Conclusion: Intradermal TXA is considered the best route, which exhibits fewer side effects with less cost and excellent outcomes, while oral TXA is found to be less preferable than other routes due to the incidence of undesirable adverse events. [ABSTRACT FROM AUTHOR]

Background: Knowing normal values of scalp hair thickness and density is beneficial for diagnosing hair disorders, monitoring responses to therapy, performing hair transplants, and conducting relevant research. Such normal values have not yet been studied for Arabs. Objective: To assess the hair density and diameter of the Arab population at different scalp sites using phototrichogram. Methods: A cross-sectional descriptive study was performed at King Saud University Medical City from December 2021 to August 2022. The study was conducted on Arab adults who were not suffering from any hair disorder. The study was conducted using a questionnaire and clinical examination by phototrichogram. Results: A total of 120 participants were enrolled in this study. The mean hair density was 147.1± 7.8 hairs/cm2, and the mean hair diameter was 87± 4.9 μm. There were significant differences between hair density (P=0.0001) and diameter (P=0.0001) in different regions of the scalp. Females had higher hair density than males at occiput (P=0.038). Conclusion: Arab hair has a higher thickness and lower density than hair of other ethnicities. This needs to be considered when diagnosing and/or treating hair problems in Arabs. [ABSTRACT FROM AUTHOR]

Background and Objective: The role of pharmacists in society is unique since they are providers of drug information and medication counseling to patients. Hence, the present study was designed to investigate the knowledge, of undergraduate pharmacy students regarding food drug (FDIs) and alcohol–drug interactions (ADIs) at King Saud University, Riyadh Saudi Arabia. Methodology: An online cross-sectional study was conducted among undergraduate pharmacy students at King Saud University, Riyadh, Saudi Arabia from October 2021 to January 2022, using self-administered 24-items questionnaires focused on evaluating the knowledge of FDIs and ADIs. Results: Of the 200 questionnaires distributed, 142 students responded, of whom 40.8% (n = 58) of the students did not agree with the statement that patients can eat more green leafy vegetables with warfarin. Just over half 52.8% (n = 75) agreed that milk affects the efficacy of tetracycline. Regarding the students' knowledge about amiodarone interactions with grapefruit 43% (n = 61) of them were knowledgeable, while 43.7% (n = 62), knew that atorvastatin cannot be taken with grapefruit. A total of 44.4% (n = 63) of the students reported being knowledgeable about FDIs. In terms of the individual questions, Alcohol interactions with antihistamines and paracetamol received the highest percentages of 52.8% (n = 75) and 50.7% (n = 72), respectively, followed by warfarin and methotrexate (45.1%; 41.5%). In this study, 39.4% (n = 56) of the participants were found knowledgeable about ADIs. The overall knowledge of interactions among the students was 47.9% (n = 68). The total knowledgeable levels were significantly associated with educational levels and having previous information about interaction (p = 0.0001). Conclusion: In conclusion, undergraduate pharmacy students exhibited poor knowledge of FDIs and ADIs. As a result, more focus and effort should be given to raising awareness of potential FDIs and ADIs. Our study highlights the need for improving pharmacy students' knowledge about FDIs and ADIs. [ABSTRACT FROM AUTHOR]

Purpose: The doctor–patient relationship is often challenged by complex communication issues and nondisclosure of important related medical information, especially in diabetes management. Very little information is known about diabetic patient nondisclosure to their doctors. The present study evaluated the prevalence of nondisclosure of information by persons with type 1 and type 2 diabetes mellitus to healthcare providers and its associated factors among the Saudi population, as well as the differences between persons with type 1 and type 2 diabetes mellitus. Methods: A cross-sectional study targeting persons with type 1 and type 2 diabetes mellitus was conducted at King Saud University Medical City, Saudi Arabia, Riyadh. An online self-administered questionnaire was used to collect data. Results: A total of 285 participants were included in the study (155 [54.4%] and 130 [45.6%] type 1 and 2 diabetic patients, respectively). Having an unhealthy diet (25.3%, n = 72), not regularly exercising (23.5%, n = 67), hiding some glucose readings (23.2%, n = 65), and not following instructions for weight loss (22.8%, n = 44) were the most common types of nondisclosed information among diabetic patients. The nondisclosure of information was significantly higher among type 2 patients (29.2%) than type 1 diabetic patients (18.7%) in terms of not participating in regular exercise (p = 0.018). Similarly, the nondisclosure of information was significantly higher among persons with type 1 diabetes compared to persons with type 2 diabetes in terms of hiding some glucose readings (p < 0.001) and not disclosing hyperglycemia (p = 0.011). Conclusion: Nondisclosure of important related medical information among diabetic patients to their healthcare providers is prevalent among the Saudi population. Furthermore, the types and causes of nondisclosed information differ among persons with type 1 and type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: Neuropathy is the most common microvascular complications among diabetic patients. Diabetic peripheral neuropathy (DPN) is the predominant variety which may associate with increased in mortality and morbidity among type 2 diabetes mellitus (T2DM). Objective: To assess the prevalence of diabetic peripheral neuropathy and its correlation with risk factors among T2DM. Methods: This was a cross-sectional retrospective study, data was collected from a previous cohort study conducted at the University Diabetes Center, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia. The data of T2DM patients were collected from case report form, included demographic data, history of chronic diabetes neuropathy, and laboratory reports. Statistical analysis includes Student's t test, chi square test, and Pearson correlation and logistic regression were performed. Results: A total of 430 patients with T2DM data was collected and analyzed, and of them 54% were females, with the mean age of 55.88 years. The prevalence of diabetic neuropathy among study participants were 40.2%, and 73.3% of them having the subtype polyneuropathy. The mean BMI; p = 0.006, FBS; p < 0.001, HbA1c; p < 0.001, cholesterol p = 0.001, LDL; p < 0.001, and triglyceride; p < 0.001 levels were a significantly higher among participants with diabetic neuropathy than without neuropathy. The male gender (Risk Ratio: 1.294, 95% CI:1.090, 1.536) p = 0.003, fasting blood glucose (Risk Ratio: 1.157, 95% CI:1.051, 1.273) p = 0.003 Cholesterol (Risk Ratio: 1.588, 95% CI:1.174, 2.147) p = 0.003, triglyceride (Risk Ratio: 1.290, 95% CI:1.086, 1.538), p = 0.004, and LDL (Risk Ratio: 1.299, 95% CI:1.073, 1.574), p = 0.007) were found to be significant risk factors for DPN. Conclusion: DPN is highly prevalent among T2DM patients in Saudi Arabia. Poor glycemic control and hyperlipidemia were associated with significantly higher risk for DPN patients among T2DM. [ABSTRACT FROM AUTHOR]

Background: Interprofessional education (IPE) in healthcare specialties is important to optimize patient outcomes and shape professional image toward teamwork and collaboration among healthcare professionals. The aim of this study is to assess the impact of IPE on pharmacy and clinical nutrition students' knowledge in food–drug interactions and readiness for interprofessional learning. Methods: This pre-post study was conducted at King Saud University between February and March 2020. We held an interprofessional workshop for pharmacy and clinical nutrition students. After we introduced the faculty members who would deliver the food–drug interactions session, the students took a seven-question quiz (total score = 7) to assess their knowledge about the basic concept of food–drug interactions before the session. After that, a 45-minute lecture was provided by a clinical pharmacy faculty member. Students from both disciplines worked on three clinical scenarios. After completing the assigned scenarios, the students retook the quiz to assess their knowledge after the workshop. In addition, student readiness was assessed using the 19-item Readiness for Interprofessional Learning Scale (RIPLS). Results: A total of 48 students were included in this study. Overall, students' mean scores in both colleges significantly increased after the workshop (p < 0.01). The mean RIPLS total scores (SD) for pharmacy students and clinical nutrition students were 80.6 (7.48) and 81.26 (6.96), respectively, out of a maximum possible score of 95. These scores indicated positive attitudes toward interprofessional learning in both groups. Conclusion: Pharmacy and clinical nutrition students' knowledge regarding food–drug interaction improved after implementing the IPE session. Students also reported higher scores for interprofessional learning. This indicates their willingness to participate in future interprofessional learning activities. Roles and responsibilities domain scores were slightly lower among both groups. Simulation-based activities including profession role exchange can be added to traditional IPE sessions to improve this domain. [ABSTRACT FROM AUTHOR]

aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users. Design: Retrospective cross-sectional descriptive study. Setting and Participants: A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022. Methods: Only individuals fulfilling the HHC program's eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients. Results: The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of < 0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. Conclusions and Implications: In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of a dental storybook on parents' knowledge about oral health of their children and to assess their perception of its effect in reducing dental anxiety levels among their children, as well as improving their oral health knowledge. Patients and Methods: This was a two-arm parallel, single-blind, randomized controlled trial (RCT) which was performed at the pediatric dental clinics in the Dental University Hospital, King Saud University, Riyadh, Saudi Arabia. Parents of 88 children (6– 8 years old) were included in the present study. Parents and their children were randomly divided into two groups as follows: the intervention group (received the storybook and verbal oral hygiene instructions) and the control group (only received verbal oral hygiene instructions; same information included in the book). Three dental visits, including screening, examination/cleaning and treatment, were provided for each child. In the screening visit, baseline parental oral health knowledge was evaluated for all parents. Afterward, parental oral health knowledge was re-evaluated in the examination visit. In the treatment visit, a parental perception questionnaire was administered to parents following treatment to evaluate their satisfaction regarding the use of the storybook in reducing anxiety levels among their children. Results: There was a significant improvement in the total knowledge score at the follow-up visit in the intervention group compared to the control group (P< 0.0001). Overall, the majority of parents perceived the storybook as a useful source of information, and they found it to be effective in reducing dental anxiety levels among their children. Conclusion: The dental storybook is an effective educational tool that can help parents become more knowledgeable about their children's oral health. Moreover, parents perceived the storybook as an effective tool for enhancing their oral health knowledge and lowering their children's dental anxiety. [ABSTRACT FROM AUTHOR]

Background: Medication non-adherence is a common and significant public health problem, especially among the geriatric population. This study's objective was to measure medication adherence and associated factors among geriatric patients with chronic diseases. Methods: A cross-sectional study targeted outpatient geriatrics who suffer from chronic diseases at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Telephone interviews were utilized to collect data from participants using a structured questionnaire and the GMAS validated instrument scale (General Medication Adherence Scale) intended to measure important determinants impacting adherence: patient behaviour, cost, comorbidity, and pill burden. Results: A total of 422 patients were assessed for medication adherence. The Mean overall score for GMAS was 29.9± 3.1 out of 33. (64.9%) of the patients had a high level of medication adherence. The patients had a high adherence on the domain of patient behavior related non-adherence (PBNA) (13.5± 1.9) out of 15, a high adherence on the domain of additional disease and pill burden (ADPB) (11.2± 1.4) out of 12, and good to high adherence on the cost-related non-adherence (CRNA) (5.25± 1.1) out of 6. Conclusion: The geriatric population with chronic diseases in our study had a good level of adherence to medication if compared with other international figures. To promote better medication adherence, patients must have a good understanding of their disease and strong beliefs about the medications prescribed. [ABSTRACT FROM AUTHOR]

aiman Alanazi,1 Mohamed Rafiullah11Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 3Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia*These authors contributed equally to this workCorrespondence: Khalid Siddiqui, Strategic Center for Diabetes Research, College of Medicine, King Saud University, P.o Box: 245, Riyadh, 11411, Saudi Arabia, Tel +966 114724179 Ext.3106, Fax +966 114725682, Email [email protected] Background: Osteopontin (OPN) is a 44-kDa multifunctional protein and has a diverse role in biomineralization, tissue remodeling, and chronic inflammation. However, its role in type 2 diabetes (T2D) patients with microvascular complications is not clear. Therefore, the present study aimed to investigate the role of OPN in T2D patients with microvascular complications. Methods: A total of 324 type 2 diabetes patients in the age group of 38– 66 years were included in this study; 249 T2D patients were diagnosed with microvascular complications. OPN was measured using an enzyme-linked immunosorbent assay kit. Clinical data, such as age, gender, diabetes duration, systolic blood pressure, diastolic blood pressure, were measured. Correlation between OPN levels with different clinical parameters was evaluated. Results: In patients with microvascular complications, OPN levels were significantly higher than those without microvascular complications (p < 0.05). Moreover, OPN levels were positively associated with systolic blood pressure (SBP), C-reactive protein, and albumin creatinine ratio (ACR). Multiple linear regression analysis showed that OPN levels were independently associated with C-reactive protein (p < 0.045). Conclusion: The findings in the present study showed that OPN level was more positively associated with C-reactive protein than that with glucose metabolism in patients with microvascular complications. Thus, OPN might serve as a marker in predicting vascular disease. [ABSTRACT FROM AUTHOR]

aimy,1 Shadin Alkatari,1 Mohamed AlMaatouq,1 Daad Alotaibi,1 Sarah Aljasser,1 Amal Aseeri,1 Anwar Jammah,1 Muhammad Mujammami,1– 3 Mona Fouda,1 Assim A Alfadda,1,2,4 Riad Sulaimani11Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 3University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia; 4Obesity Research Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Aishah Ekhzaimy, Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia, Email [email protected] Purpose: Impact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women. Patients and Methods: This is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan. Results: Pregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009). Conclusion: The present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control. Recommendation: Religious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between urinary stone type and the type of crystals in the urine. Patients and Methods: This retrospective study involved 485 patients with urinary stones treated at King Saud University Medical City from May 2015 to June 2017. Clinical data were obtained from medical records. Different statistical analysis methods were applied, including basic contingency analysis, analysis of variance, logistic regression, discriminant analysis, partition modeling, and neural network evaluations. Results: Of 485 patients, 47 had crystals detected by urinalysis. The most common type of crystal was calcium oxalate (n = 31), which had the highest association with calcium oxalate stones. Uric acid crystals (n = 8) were associated with uric acid stones. The neural network model used for determining the sensitivity and specificity showed an R-square value of 0.88, with an area under the curve of 0.94 for calcium oxalate, 0.94 for carbonate apatite, and 1.0 for uric acid. Conclusion: The predictive algorithm developed in the present study may be used with a patient's clinical parameters to predict the stone type. This approach predicts the stone types associated with certain patient characteristics with a high sensitivity and specificity, indicating that the models may be a valuable clinical tool in the diagnosis, management, and monitoring of stone diseases. [ABSTRACT FROM AUTHOR]

aim,2 Sara Alqahtani,2 Hadeel Alkofide31Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 2Pharmaceutical Care Services, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ghazwa B KorayemPharmacy Practice Department, College of Pharmacy, Princess Nourah bint Abdulrahman University, Al Imam Abdullah Ibn Saud Ibn Abdul Aziz Road, Riyadh, Saudi ArabiaTel +966 504161649Email [email protected] Purpose: To identify factors associated with inappropriate acid-suppressive therapy (AST) use in hospitalized medical ward patients. Patients and Methods: This was a combined retrospective cohort study reviewing the electronic medical records of medical ward in a secondary university hospital between January 2018 and July 2019, in addition to prescriber surveys about AST knowledge. We included adult patients (≥ 18 years old) admitted to the medical ward who received at least one dose of AST during their hospitalization. Statistical analyses included descriptive statistics and logistic regression. Results: A total of 335 patients were included. Most of the patients were female (66.6%), with a mean age of 42.37 ± 17.72 years; 76% (n=256) of the study subjects were prescribed AST for an inappropriate indication. Patients who were not receiving any home medications associated with high bleeding risk had higher odds of being prescribed AST inappropriately (OR, 4.06; 95% CI, 1.09– 13.8). A total of 27 physicians completed the prescriber survey, and the average prescriber's knowledge score was 46.8 ± 15.6%. This score did not differ by the prescriber's position. Conclusion: This study demonstrated the overuse of AST in the medical ward. Therefore, improving providers' awareness about AST and implementing an AST stewardship program in institutions is necessary to limit this long-lasting issue. [ABSTRACT FROM AUTHOR]

Background: Experiential learning is useful for fostering the development of a wide range of clinical and practical skills. This study aimed to determine the usefulness of experiential learning for psychomotor skills development of emergency medical services (EMS) students. Methods: An action research approach was used because it is useful for linking theory with action and practice. The Field Internship Student Data Acquisition Project (FISDAP) tool was used to assess and monitor students' performance and competencies achievement in psychomotor skills. The study was conducted at Prince Sultan College for Emergency Medical Services (PSCEMS), King Saud University (KSU). Skills performance of 71 EMS students were analysed in the experiential learning implemented throughout the curriculum over 3 years. Results: The finding indicates that the students' skills performance falls below the minimum requirement during the clinical practicum and significantly improves during the time of internship period. The overall success rate ranges between 26.58% and 35.74% across all the psychomotor skills, whereas during the internship year student's success rate ranges between 85.49% and 99.4% across all the psychomotor skills. Conclusion: The findings of this study are promising and show that experiential learning is a useful and effective way to develop psychomotor skills and competencies in EMS students. Educators and policymakers can use the findings for strategizing policies for curriculum planning and development. [ABSTRACT FROM AUTHOR]

aimed to evaluate the impact of the COVID-19 pandemic on the knowledge and attitudes of patients among the Saudi population toward participating in clinical trials. Methods: We conducted a descriptive, cross-sectional analysis using self-administered questionnaires for patients who attended the outpatient clinics at King Fahad Medical City and King Saud University Medical City in Riyadh, Saudi Arabia. The questionnaires included general questions about sociodemographic information, patient knowledge about clinical trials, and patient attitudes toward clinical trial participation. We used descriptive analysis to evaluate the impact of COVID-19 on patient knowledge and attitudes about clinical trials. Results: From November 2019 to October 2020, 822 responses were collected from participants in two medical cities and included in the analysis. Most of the study participants (81%) were younger than age 42 years. Our findings showed no difference between participants who participated in clinical trials before versus during the COVID-19 pandemic (P = 0.129). Conclusion: The Saudi population knows about clinical trials, but they lack knowledge about the role of the ethics committee and about informed consent. Also, most of them do not have the experience of participating in a clinical trial. Still, they have moderately positive attitudes toward clinical trials. [ABSTRACT FROM AUTHOR]

aim,1 Nora Alorf,2 Ward Alessa,2 Ghada Bawazeer11Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 2College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Hadeel AlkofideDepartment of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11149, Saudi ArabiaTel +966503225121Email [email protected] Purpose: Cardiotoxicity is a common complication associated with anthracyclines. Little is known regarding the rate of anthracyclines-related acute and chronic cardiotoxicity and adherence to cardiac monitoring recommendations among cancer patients. Patients and Methods: A single-centre retrospective cohort study was conducted from 2015 to 2018 on patients with cancer, 18 years of age and older, on anthracyclines without a history of cardiovascular diseases. Data on demographic information, comorbidities, cardiovascular events, monitoring parameters, and treatment details were obtained. The primary outcome was the incidence of anthracyclines-related cardiotoxicity both acute and chronic. The secondary outcome was to determine adherence to guideline recommendations for monitoring anthracyclines-related cardiotoxicity based on the American Society of Clinical Oncology clinical practice guidelines. Analyses included descriptive statistics and logistic regression. Institutional review board approval was obtained. Results: In 235 patients identified, 28.9% developed cardiotoxicity, of which 27.2% were acute, while chronic cardiotoxicity was observed in 8.9% of subjects. Patients who received optimal cardiac monitoring had a statistically significant higher odds of developing cardiotoxicities (odds ratio=2.65, confidence interval=1.32– 5.33). The risk of cardiotoxicity was higher in subjects with a history of diabetes mellitus, those using daunorubicin, and concomitant filgrastim use. Adherence to guideline recommendations was only achieved in 25.1% of the population. Echocardiography was the most common monitoring method used. Conclusion: In this study, there was a high incidence of anthracyclines cardiotoxicity and poor compliance with cardiac monitoring recommendations for cancer patients on anthracyclines, which underscores acute and chronic cardiotoxicity in this population. [ABSTRACT FROM AUTHOR]

Purpose: Special technical issues associated with the function and maintenance of medical devices arise in intensive care units (ICUs). This study explored the level of comfort of ICU staff in dealing with selected equipment, the factors that are associated with the staff's ease of adaptation to new technologies, and the role of technical support staff. Patients and Methods: This is a single-center cross-sectional questionnaire-based survey that was conducted in February 2018 and targeted nurses working in the ICUs of King Saud University Medical City in Riyadh, Saudi Arabia. Results: Among the 297 nurses who completed the survey, almost all of the respondents (99.3%) were aware of the ICU equipment preventive maintenance program. Most of the nurses had received training on how to use infusion pumps (96.2%), cardiac monitoring systems (78.0%), and cardiac defibrillation devices (73.9%). Sixty nurses (20.2%) indicated that at least one super user was available for at least one device. About half of the staff reported one device whose user manual was available. Most nurses reported having no resources regarding updates on medical devices. Conclusion: Our findings revealed an alarming need to address technical issues related to medical devices used in the ICU and to design a framework for the safe operation of medical devices based on international practices. It is necessary to empower the role of the super user and medical device clinical educator as well as to optimize communication between the national regulatory body of medical devices and healthcare providers, especially those working in acute care areas. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease (COVID-19) is a global pandemic with more than 60 million cases worldwide and over 1.5 million deaths by March 2021. Its outbreak has caused a huge burden on healthcare systems all over the world. Several studies in the medical literature have suggested that patients with underlying cardiovascular disease (CVD) are at higher risk for developing severe symptoms, poor prognosis, and high mortality rates. The aim of this study was to assess the prevalence of CVD risk factors among COVID-19 patients based on the Framingham risk score (FRS), and to evaluate the association of CVD risk factors with clinical outcomes.Patients and Methods: In this retrospective cross-sectional study, we identified 264 confirmed cases with COVID-19 at King Saud University Medical City in Riyadh, Saudi Arabia. Patients aged 18-80 years were included, and their electronic records were reviewed. They were classified into low, intermediate, and high risk of CVD according to FRS classification.Results: Two-hundred-six patients (67% male) were included in this study. The mean age was 55.3 ± 15.1 years. Most patients had comorbidities: the most common were hypertension (48.1%), diabetes (45.1%), and ischemic heart disease (11.2%). More than half required intensive care admission, and 58 (28.2%) patients died. Pneumonia was the most frequently observed complication (85%), followed by mechanical ventilation (28.3%) and acute kidney injury (27.7%). Age, male gender, hypertension, and diabetes mellitus showed significant differences between FRS categories, and were associated with intermediate and high-risk groups of FRS (p < 0.05). Pneumonia and length of stay were associated with the Intermediate risk group of FRS.Conclusion: Cardiovascular disease risk factors are prevalent in Saudi patients infected with COVID-19. FRS could be a useful tool to identify CVD risk factors among COVID-19 patients and predict a complicated course. [ABSTRACT FROM AUTHOR]

Background: The objective of this qualitative study was to explore the value of virtual IPE competition that involved a COVID-19 case among healthcare students and the lessons that can be learned to improve this experience in the future. Methods: The 27 senior students from the colleges of medicine, pharmacy, nursing, and paramedics were invited to two focus groups that followed the IPE competition and lasted 60 minutes each. A semi-structured focus group discussion guide was used in the focus group discussion to explore the benefits and limitations of the virtual IPE experience. Verbatim transcription of the two video-recorded sessions was conducted, and inductive thematic analysis was performed to uncover different emerging themes. Results: The number of students who consented to participate was 16 (59.26%). The IPE virtual competition was perceived favorably by all students; however, multiple organization and communication barriers were reported. Although the participants liked the IPE virtual competition, they clearly stated their preference for an in-person IPE competition over the virtual one. Managing a COVID-19 case was not perceived favorably by some participants due to the absence of evidence-based clinical guidelines supporting certain treatment protocols over others. Thus, some participants preferred a non-COVID-19 case where clear and evidence-based guidelines exist. Conclusion: The use of different IPE strategies to enhance healthcare students' collaboration and understanding of their roles in the multidisciplinary healthcare team, especially during pandemic times, such as COVID-19, is possible. Future studies should examine new and innovative IPE strategies that address the identified limitations of virtual IPE. [ABSTRACT FROM AUTHOR]

aimy,5 Alena Strizek61Evidera, Bethesda, MD, USA; 2Eli Lilly and Company, Indianapolis, IN, USA; 3Eli Lilly and Company, Riyadh, Kingdom of Saudi Arabia; 4Evidera, London, UK; 5King Saud University, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia; 6Eli Lilly, Sydney, AustraliaCorrespondence: Heather L GelhornEvidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814, USATel +1 970-363-7333Email heather.gelhorn@evidera.com Background: The Kingdom of Saudi Arabia (KSA) has the second highest prevalence of type 2 diabetes mellitus (T2DM) in the Middle East. There is a paucity of research on the experiences and treatment preferences of patients with T2DM in KSA. This study explored Saudi patients' health-related quality of life, eating habits, experiences during Ramadan, and preference between two glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment devices. Methods: A cross-sectional, observational study was conducted in three cities in KSA. Participants completed sociodemographic and clinical forms, EQ-5D-5L, Impact of Weight on Self-Perceptions, and a diabetes treatment survey. Participants also viewed instructional videos on GLP-1 RA injection devices and indicated their device preference. Results: Of the 310 participants, 53% were male. The mean age was 43 years (range: 30.0– 75.0), duration since diabetes diagnosis was 6.3 years (range: 0.2– 27.1), the most commonly reported last HbA1c level was between ≥ 7.1% and 8% (45%). The mean EQ-5D-5L index score was 0.90, with some participants reporting problems with pain/discomfort (34.5%) and usual activities (33.2%). Patients reported a low-to-moderate impact of weight on self-perception. In preparation for Ramadan, participants sought physician advice on diabetes management (37%) and/or increased checks of their blood glucose (37%). After watching the videos, 89% (n=277) of participants indicated a device preference, with significantly more preferring the dulaglutide device (n=186, 67%) over the semaglutide device (n=91, 33%) (p< 0.0001). Conclusion: This study indicates that T2DM has a significant social, emotional, and behavioral impact on the lives of patients in KSA. [ABSTRACT FROM AUTHOR]

Background: Collaborative interprofessional practice improves health outcomes. Interprofessional education (IPE) is essential in improving this collaboration and the quality of care. Although the majority of IPE research focuses on students, the delivery of IPE requires multiple levels of support within educational institutions, particularly teaching staff that are positive about and advocate for IPE. This study explored the attitudes of teaching staff towards interprofessional collaboration across a range of professions in Health at King Saud University, Saudi Arabia. Methods: A pre-test post-test design was used with 53 teaching staff from the Health Colleges, King Saud University, before and after an interprofessional development workshop. A 12-item, 3-subscale version of the IEPS was used to evaluate changes in the 3-subscales "competency and autonomy", "perceived need for cooperation" and "perception of actual cooperation". Results: This study involved teaching staff from medicine, nursing, pharmacy, dentistry, applied medical science and emergency medical services. Results showed positive attitudes towards IPE, including competency and autonomy, the need for cooperation, and the perception of actual cooperation. The analysis also showed a statistically significant effect of subscale 1 (competency and autonomy) was produced between the pre- and post-workshop training. Conclusion: Interprofessional collaboration across the Health Colleges is an essential component of IPE, just as IPE is an integral component of interprofessional collaborative practice. The findings provided a baseline, as well as an incentive, for further development in IPE, from policy through to practice, across the Health Colleges. Findings also showed teaching staff having a positive attitude towards interprofessional collaboration. Further research is needed on tools for measuring IPC across university hierarchies and disciplines, as well as on enablers of IPE (and not just barriers). [ABSTRACT FROM AUTHOR]

aiman,1 Abdulrahman Almizel,1 Abdulrahman Barri,1 Fadwa Al Adel21College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Fadwa Al Adel Email FFAladel@pnu.edu.sa Background: Diabetes mellitus (DM) and its complication present a major morbidity burden among Saudi population. Awareness and proper knowledge of this highly prevalent disease is crucial to enhance early detection and proper intervention. Therefore, the main aim of this study was to identify the knowledge, attitude, and practices (KAP) of diabetic patients towards diabetes and diabetic retinopathy in Riyadh, Saudi Arabia. Methods: This cross-sectional study was conducted in 50 randomly selected primary care centers and two university hospitals in Riyadh, Saudi Arabia, between May and December 2018. Diabetic patients ≥ 18 years old were enrolled in the study. A validated KAP-45 questionnaire was used to assess the KAP levels of diabetics towards diabetes and diabetic retinopathy. Results: A total of 313 participants were enrolled in the study. The majority were males 168 (59.8%). The median age was 49 ± 24, and the median duration of diabetes was 8 ± 11 years. The average knowledge score for diabetes was 10 (good). While the average knowledge score for diabetic retinopathy was 4.5 (suboptimal). The average attitude scores for both diabetes and diabetic retinopathy were 0 and 2 (suboptimal), respectively. The average practice score for diabetes was 5 (good) while it was 3 (low) for diabetic retinopathy. The most common barrier to comply with regular follow-up was inadequate knowledge about the importance of periodic eye exam 47.1% (107). Patients with low socio-economic status had a significantly poor knowledge regarding diabetes (P< 0.0001) and diabetic retinopathy (P< 0.015), respectively. However, patients with low educational level had a significantly poor knowledge (p< 0.0001) and poor practice regarding diabetes (P< 0.013), respectively. Conclusion: It is important to improve education and awareness of DM and diabetic retinopathy among diabetics, as it's essential for controlling the disease and reducing its complications, by improving patient compliance to treatment and follow-up. [ABSTRACT FROM AUTHOR]

Purpose: The risk of acquiring coronavirus disease 2019 (COVID-19) among dental professionals is high because they are exposed to aerosol production and body fluids during dental procedures. Therefore, the aim of the study was to determine the level of awareness among the dental students regarding COVID-19. Materials and Methods: An online cross-sectional questionnaire with three sections (knowledge, attitudes, practice) was completed by 412 postgraduate and undergraduate dental students and interns from King Saud University in Saudi Arabia. Results: The overall mean survey score was 9.56± 1.19 out of 15. A mean score of 2.31± 0.32 was recorded for level of knowledge among the dental professionals that indicated a fair level of knowledge among the participants. Similarly, a mean score of 6.5± 0.45 was recorded for attitude of dental professionals towards COVID-19 that indicated a moderate level of attitude. "Novel COVID-19 virus transmits through droplets," and "masks should be worn most of the time to prevent infection spread," had the lowest correct answer rates. The practice had a low mean score of 0.81± 0.22. The results depicted statistically significant differences in knowledge, with postgraduate students having the highest mean scores, followed by interns and undergraduate students. Conclusion: Despite attaining fair scores on knowledge and attitudes, the low practice scores highlight the need for urgent strategies to prevent infection among dental students, including mandatory crash courses and hands-on protection measures. [ABSTRACT FROM AUTHOR]

aimi, 2 Abdulrahman Z Alanazi, 2 Mohammad N Alamri, 2 Bader A Alshehri, 2 Saif M Alosaimi 2 1Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Haytham I AlSaifDepartment of Family and Community Medicine, College of Medicine, King Saud University, P.O. Box 2925, Ext. 34, Riyadh 11461, Saudi ArabiaTel +966 565454685Email drhalsaif@gmail.com Purpose: The coronavirus disease 2019 (COVID-19) pandemic may increase demand for healthcare professionals (HCPs), either because of a HCP shortage due to illness or because of the need to increase surge capacity. Final-year medical students are one of the resources potentially available to expand the workforce. There is a need to explore the willingness of final-year medical students to meet this demand, examine their perceived competence, and determine how their overall perceived competence correlates with their willingness. Methods: A cross-sectional study using a self-administered electronic questionnaire was used. The questionnaire included demographic data, students' self-perceived competence derived from the patient care theme of the Saudi Medical Education Directives (SaudiMED) framework, and their willingness to be measured on a 5-point Likert scale. The study targeted final-year medical students at King Saud University, Riyadh, Saudi Arabia. Results: The number of participants was 134 (56.1% response rate), of whom 47 students (34.3%) were willing to work, while 31 (23.1%) were somewhat willing. The mean total self-perceived-competence score was 58.36/88 (66.3%). Demonstration of essential clinical skills had the highest mean score 11.48/16 (71.8%) among learning outcomes. There was a positive moderate correlation between willingness and mean perceived-competence score (Spearman correlation coefficient=0.45, p< 0.001). Conclusion: Fifty-seven percent of medical students were willing to work as part of the healthcare workforce during the COVID-19 pandemic. Better overall self-perceived competence appeared to correlate with more willingness. Students perceive themselves to be more competent in essential clinical skills. Appropriate training and supervision are suggested in all tasks assigned to them, with additional care required in areas with a lower perceived competence, such as prescription writing and essential clinical procedures. [ABSTRACT FROM AUTHOR]

aim,1 Jawza Albaqami,1 Rawan Al Shalhoub,1 Ibrahim Almaghlouth,2,3 Maha Dessougi,4 Amal Al Harthi,4 Mohamed Bedaiwi,2 Eman Alfi,5 Mohammed A Omair21Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 2Rheumatology Unit, Department of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia; 3College of Medicine Research Centre, King Saud University, Riyadh, Saudi Arabia; 4Rheumatology Department, Security Force Hospital, Riyadh, Saudi Arabia; 5Clinical Pharmacy Department, Pharmaceutical Services, King Saud University Medical City, Riyadh, Saudi ArabiaCorrespondence: Haya Almalag Department of Clinical PharmacyCollege of Pharmacy, King Saud University, Riyadh 11149, Saudi ArabiaTel +966 118057859Email halmalaq@ksu.edu.sa Background: Methotrexate (MTX) Intolerance Severity Score (MISS) has been previously validated in the Arabic language and has helped to detect high levels of intolerance in rheumatoid arthritis (RA) patients. The aim of the current study was to evaluate patient and disease characteristics associated with a high risk of MTX intolerance. Materials and Methods: A cross-sectional interview-based survey was conducted using adult RA patients as a study group, who were visiting a specialized rheumatology clinic at King Saud University Medical City. The Arabic MISS was used in this survey. Statistical analyses were performed to understand associations between MTX-intolerant and MTX-tolerant patients. Results: A total of 117 patients were involved in this study. Of those, 101 (86.3%) were females with a mean (SD) disease duration of 6.6 (5.7) years. The median (interquartile range (IQR)) Disease Activity Score-28 (DAS28) was 3.6 (3.6– 4.1). MTX intolerance was observed in 55 (47%) patients. The most predominant component in patients with a positive test was the behavioral component. Intolerant patients had a higher median of pain (47.3 vs. 50.0; P = 0.010) and patient global assessment (50.0 vs. 60.0; P = 0.004) scales compared to those in tolerant patients. Additionally, MTX intolerance was associated with the female gender (adjusted odds ratio (AOR) 6.724; 95% CI 1.420, 31.843, P = 0.016), marital status (AOR 2.549; 95% CI 1.037, 6.270, P = 0.042) and DAS28 (AOR 1.612; 95% CI 1.032, 2.517, P = 0.036). There was no significant difference between the two groups in the remaining disease activity parameters, background therapies, seropositivity, and smoking status (P > 0.05). Conclusion: Patient characteristics, rather than disease activity, significantly impact MTX intolerance. Behavioral component is the main driver of intolerance. Intolerant patients have higher patient-reported outcomes. Qualitative studies are needed to explore causes and potential solutions to MTX intolerance. [ABSTRACT FROM AUTHOR]

Purpose: Dietary supplements (DSs) are popular in many countries, and their use among individuals is increasing worldwide. Therefore, this study aimed to assess the prevalence and use of DSs among pharmacy students in King Saud University College of Pharmacy, Riyadh, Saudi Arabia. Methods: This study used a cross-sectional design targeting male senior pharmacy students in their fourth and fifth years of Bachelor and Doctor of Pharmacy courses. The data were collected between August and October 2019 using paper-based questionnaires. Results: A total of 46.8% of the students used DSs. Of all students surveyed, 19% used branded supplements whereas 9.7% used generic or local supplements and 12.3% used both generic and branded supplements. Furthermore, 8.2% students suffered from side effects, including 5.6% who suffered from nausea, vomiting, and diarrhea and 2.6% who suffered from headache, confusion, and disorientation. Approximately 24.6% of students used fiber DSs whereas 19% and 16.4% used DSs for protein and glucosamine/omega 3 fatty acids, respectively. Conclusion: The study findings indicated that the prevalence of DS use is increasing. However, approximately half of the respondents encourage the use of DSs only with a doctor's recommendation. Educating about the safe use of DSs is warranted. [ABSTRACT FROM AUTHOR]

aimed to assess and compare insulin resistance and metabolic profile in sarcopenic and non-sarcopenic obese Saudi adult men. Methods: This cross sectional study was conducted at the College of Sports Sciences, King Saud University, Riyadh. We recruited 312 Saudi adult male individuals and 288 were finally selected for the study. Body composition analysis and hand grip strength (HGS) were estimated by bioimpedance analysis (BIA) and dynamometer in all subjects, respectively. Fasting blood samples were collected for glucose (FBG), basal insulin (BI) and lipid profile. The subjects were divided into three groups based on the body composition parameters, appendicular lean mass (ALM) and body fat percentage (BF%), into non-obese (NonOb) [Normal ALM+< 25 BF%], obese without sarcopenia (ObNonS) [Normal ALM+> 25 BF%] and obese with sarcopenia (ObS) [Low ALM+> 25 BF%]. Results: Obese subjects had significantly higher BI, HOMA-IR and HOMA-β compared to non-obese. Moreover, comparison between two obese groups revealed that both BI and HOMA-IR levels were higher in ObS subjects compared to ObNonS individuals revealing that sarcopenia exacerbates the insulin resistance profile. There was a significant trend of higher resistance and lower sensitivity from non-obese to obesity with sarcopenia. Total cholesterol (TC) and triglycerides (TG) were significantly higher and high density lipoprotein cholesterol (HDL-C) was significantly lower in sarcopenic obese subjects compared to non-sarcopenic obese individuals. The worsening effects were more significant at cutoff point of 7.46 on insulin indices and lipid profile showing that sarcopenia associated with obesity exacerbates the dyslipidemia. Conclusion: Our study shows that obesity associated with sarcopenia exhibits significantly greater insulin resistance and dyslipidemia than sarcopenia or obesity per se. Therefore, sarcopenic obesity might be an independent risk factor for metabolic disease progression. [ABSTRACT FROM AUTHOR]

Background: Electrocardiography is an essential emergency tool used in the pre-hospital setting. However, no studies have yet assessed electrocardiogram (ECG) interpretation among emergency medical services (EMS) students in Saudi Arabia. This study aimed to determine the ECG interpretation competency of paramedic students. Methodology: Cross-sectional, single-center study, a pre-validated, self-administered, two-part questionnaire first created by Coll-Badell et al was used to assess the ECG interpretation competency of paramedic students at Prince Sultan College for Emergency Medical Services (PSCEMS) in King Saud University. Participant data were collected and analyzed to identify factors associated with improved competency. Results: All students of PSCEMS were included, and 137 of 248 paramedic students completed the questionnaire (55% response rate); 88 students (64.2%) scored > 7.5 points, indicating competency in (ECG) interpretation. Factors such as grade point average (GPA) (> 3.5) and enrollment in cardiology and advanced cardiac life support courses were found to be significantly associated with competency (p< 0.001). Conclusion: The majority of paramedic students were found to be competent in ECG interpretation. GPA and enrollment in cardiology and advanced cardiac life support courses were significantly associated with improved competency. [ABSTRACT FROM AUTHOR]

aimi,3 Yazed AlRuthia,1,4 Abdulkarim M Meraya,5,6 Bander Balkhi,1,2 Ahmed Aldemerdash,1 Hadeel Alkofide,1 Tariq M Alhawassi,1,2 Abdulmajeed Alqasoumi,3 Khalid M Kamal71Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 2Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 3Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia; 4Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 5Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia; 6Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia; 7Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA, USACorrespondence: Monira AlwhaibiDepartment of Clinical Pharmacy, King Saud University, College of Pharmacy, Riyadh 11149, Saudi ArabiaTel +966 535384152Email malwhaibi@ksu.edu.sa Background: Statins are widely utilized antidyslipidemics with a proven track record of safety and efficacy. However, the efficacy of these therapeutic agents hinges on patients' adherence to their prescribed statins. Objective: The primary objectives of this study were to examine the relationship between adherence to prescribed statins and its impact on the low-density lipoprotein (LDL) level, and to explore the factors that influence patient adherence to statins among patients with diabetes and dyslipidemia. Methods: This was a retrospective, cross-sectional study using the electronic health records data of adults (≥18 years) with type 2 diabetes and dyslipidemia visiting outpatient clinics at a university-affiliated tertiary care center. Adherence to statin therapy was estimated using the proportion of days covered (PDC). Patients with diabetes were considered adherent to statins if they had a PDC of ≥80%. Treatment success was considered if the LDL level of < 2.6 mmol/L. Results: Out of 10,226 of patients with diabetes, 1532 met the inclusion criteria and were included in the study. Seventy-nine percent of the patients with diabetes were on atorvastatin and 21% were on simvastatin. The vast majority of the patients with diabetes (77%) were considered adherent and about 42% achieved LDL-cholesterol goal < 2.6 mmol/L. No association between adherence to statin therapy and LDL goal attainment was observed. Women had lower odds of being adherent to statin therapy (AOR=0.66, 95% CI: 0.49–0.87) compared to men. Further, young adults (18–44 years) had lower odds of being adherent to statin therapy (AOR=0.58, 95% CI: 0.32–0.97) compared to older adults (age>65 years). Conclusion: The findings of this study highlight the need to examine the impact of adherence to statins on healthcare services utilization due to different complications of uncontrolled dyslipidemia. [ABSTRACT FROM AUTHOR]

aimi,1 Deemah A AlAteeq,2 Sarah I Bin Hussain,3 Riham S Alhenaki,4 Abdullah A Bin Salamah,5 Noor Adnan AlModihesh11Department of Psychiatry, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 3Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 4Department of Pediatrics, King Abdullah Specialized Children's Hospital, KAMC, MNGHA, Riyadh, Saudi Arabia; 5Department of Family and Community Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Deemah A AlAteeqCollege of Medicine, Princess Nourah Bint Abdulrahman University, P.O. Box 93949, Riyadh 11683, Saudi ArabiaEmail DAalateeq@pnu.edu.sa Objectives: To examine public's knowledge, beliefs, and attitudes toward bipolar disorder (BP) in Saudi Arabia (SA). Methods: A cross-sectional survey was performed in 2016 in Riyadh, SA. The survey included sociodemographic characteristics and BP awareness scale. Results: Of 416 participants, 49.5% had prior knowledge of BP, mainly from internet and social media, and 57% considered it to be common in SA. About half believed BP is caused by a neurophysiological or neurochemical imbalance and that it can be treated with psychiatric medications. Supernatural causes, weak faith, and weakness of character were considered causes of BP by 55%, 48%, and 40% of participants, respectively. Recreational activities and head bandaging by traditional therapists were considered viable treatment options by 55% and 41% of participants, respectively. Students and healthcare professionals scored significantly higher on awareness scale. Regarding attitude, a majority believed that persons with BP can work effectively ‎(86%)‎, have to pull themselves together to get over it (47%), and consider it a shame to mention that someone in a family is affected by BP (32%). Regarding relationships, 22% were not willing to maintain a friendship and 39.3% were not willing to marry someone with BP. Conclusions: This study revealed suboptimal public awareness towards BP in SA. It identified several misconceptions and negative attitudes toward patients with BP. Further studies are needed to investigate potential public interventions to improve literacy of BP. [ABSTRACT FROM AUTHOR]

Background: High sensitivity C-reactive protein (hsCRP) predicts myocardial dysfunction after acute coronary syndromes. We aimed to study the association of hsCRP estimation at first acute myocardial infarction (AMI) with myocardial dysfunction and heart failure. Methods: This research was carried out at the Department of Physiology and Department of Emergency Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia. In this prospective study, 227 patients were studied. hsCRP levels were estimated when patients came to the emergency department at AMI, 7 days post AMI, and at 12 weeks of follow up after AMI. The outcome was change in myocardial functions, especially heart failure, 12 months after the attack. Results: Based on a cutoff mean value of hsCRP levels at admission (10.05±12.68 mg/L), patients were grouped into high and low C-reactive protein (CRP.) The ejection fraction was significantly lower at follow up in the high CRP group (37.29±12.97) compared to the low CRP group (43.85±11.77, p<0.0198). hsCRP had significant inverse correlation with left ventricular ejection fraction (r=-0.283, p<0.01). About 38.1% patients showed heart failure, with 23.6% in the high CRP group and 14.5% in the low CRP group (OR 2.4, p=0.028). Receiver operating characteristic curve analysis showed that CRP levels at AMI had a specificity of 79% and sensitivity of 83% to predict heart failure. Conclusion: A high hsCRP level measured at first AMI predicts myocardial dysfunction and heart failure. It is suggested that hsCRP plays an important role in the development of heart failure after myocardial infarction. [ABSTRACT FROM AUTHOR]

aiman Al-Habib Medical Group, Riyadh, Saudi Arabia; 2Department of Dermatology, Prince Mohammed Bin Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Nujud DahamDepartment of Dermatology, Dr. Sulaiman Al-Habib Medical Group, King Fahad Road, Olaya, Po Box 91877, Riyadh 11643, Saudi ArabiaTel +966 500211134Email nujud.daham@gmail.com Adalimumab is a fully human, recombinant, IgG1 monoclonal antibody that targets tumor necrosis factor-alpha (TNF-alpha). It has been established that adalimumab can cross the placenta and can be detected in the fetal circulation for up to 6 months postpartum. However, clinical studies have failed to show any consistent or specific adverse fetal outcomes from maternal exposure to adalimumab during pregnancy. In our report, we present a case of fetal acrania (exencephaly) in the setting of a pregnant female taking adalimumab prior to and during pregnancy. Exencephaly is a neural tube defect (NTD) that results from failure of closure of the neural fold. It is true that there were other risk factors that might have contributed to our patient's unfortunate outcome. For example, she did not take folic acid supplementation prior to or during her pregnancy. Nonetheless, studies have shown that folic acid deficiency alone is not sufficient to lead to the development of NTDs. Our patient's exposure to adalimumab during her pregnancy might have added to the risk in her situation. Our report aims to inform clinicians of that possible risk and to stimulate them to report any similar outcomes. [ABSTRACT FROM AUTHOR]

purpose of this research" should read "The authors acknowledge the support provided by the Deanship of Scientific Research at King Saud University, through the Research Center at College of Nursing. Furthermore, the authors are very thankful to all the associated personnel in any reference that contributed in/for the purpose of this research".The authors apologize for this error. Read the original article [ABSTRACT FROM AUTHOR]