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Background: Fever, thrombocytopenia, hemolysis, pentad failing kidneys, anaemia, and neurological impairment has historically been used to describe bleeding as the blood syndrome “thrombotic thrombocytopenic purpura” (TTP), a type of hemolytic anaemia caused by microangiopathy. TTP is an uncommon condition, and it is unclear exactly how often it is? According to studies, incidence per million depends on where individuals live. TTP can occur in youth with congenital forms, however it mostly strikes adults over the age of 40. The two organ systems most frequently impacted by TTP are the nerve system of the body (CNS) and kidneys. Because TTP is a serious medical condition with a 90% fatality grad if untreated, prompt diagnosis is crucial. Initial therapy is effective in around 80% of patients, and post-treatment mortality is between 10% and 15%. Objectives: The study aimed to summarize current evidences regarding epidemiology and outcomes of Thrombotic Thrombocytopenic Purpura therapy (TTP). Methods: For article selection, the PubMed database and EBSCO Information Services were used. All articles relevant with our topic and other articles were used in our review. Other articles that were not related to this field were excluded. The data was extracted in a specific format that was reviewed by the group members. Conclusion: Older patients had longer Immune thrombotic thrombocytopenic purpura (iTTP) episodes and died at higher rates than younger patients. iTTP patients have a considerable increase in chance of illness and demise, while receiving TPE and immunosuppressants, which necessitate the need for more potent treatments. Moreover, they are more likely to have secondary thrombotic microangiopathies than primary microangiopathies due to several causes. Depending on the origin of thrombotic microangiopathies, there are different risks associated with dialysis, neurologic and cardiac issues, and mortality. Mortality rate are low for patients who received hospital care with low rate of complications.

Objective: This study was undertaken to elaborate the precautionary methods taken by the College of Medicine of Qassim University for conduction of students’ academic examinations (exams) in the university campus during the COVID-19 pandemic. Methods: This study was conducted on undergraduate medical students (n=674) from the September 2020 to April 2021 in the College of Medicine at Qassim University. The switch into conducting exams within the center was managed by the exam committee. Multiple online workshops were conducted to the staff and students regarding the precautionary measures and the exam procedures in order to prevent the transmission of the disease among students and staff. New guidelines for undertaking the exams were designed and implemented at the exam centers in the university campus during COVID-19 pandemic. Results: All the exams were conducted in a satisfactory manner under one roof under the supervision of the invigilation team within the examination center located in the university campus. The strict implementation of precautionary guidelines and the crucial steps to prevent the spread of Coronavirus facilitated the accomplishment of this vital task in a smooth manner with no case of COVID-19 reported in any of the staff or students who participated in this activity. Conclusions: This study revealed the precautionary methods and steps undertaken by the college of medicine, Qassim University in terms of conducting exams within campus. We concluded that if implementation of precautionary measures should be carried out in a proper manner then it is possible to conduct exams under one roof.

Mango fruit is well known for its nutritional and health benefits due to the presence of a plethora of phytochemical classes. The quality of mango fruit and its biological activities may change depending upon the variation in geographical factors. For the first time, this study comprehensively screened the biological activities of all four parts of the mango fruit from twelve different origins. Various cell lines (MCF7, HCT116, HepG2, MRC5) were used to screen the extracts for their cytotoxicity, glucose uptake, glutathione peroxidase activity, and α-amylase inhibition. MTT assays were carried out to calculate the IC50 values for the most effective extracts. The seed part from Kenya and Sri Lanka origins exhibited an IC50 value of 14.44 ± 3.61 (HCT116) and 17.19 ± 1.60 (MCF7). The seed part for Yemen Badami (119 ± 0.08) and epicarp part of Thailand (119 ± 0.11) mango fruit showed a significant increase in glucose utilization (50 μg/mL) as compared to the standard drug metformin (123 ± 0.07). The seed extracts of Yemen Taimoor seed (0.46 ± 0.05) and Yemen Badami (0.62 ± 0.13) produced a significant reduction in GPx activity (50 μg/mL) compared to the control cells (100 μg/mL). For α-amylase inhibition, the lowest IC50 value was observed for the endocarp part of Yemen Kalabathoor (108.8 ± 0.70 μg/mL). PCA, ANOVA, and Pearson’s statistical models revealed a significant correlation for the fruit part vs. biological activities, and seed part vs. cytotoxicity and α-amylase activity (p = 0.05). The seed of mango fruit exhibited significant biological activities; hence, further in-depth metabolomic and in vivo studies are essential to effectively utilize the seed part for the treatment of various diseases.

Objective: This study aimed to compare the prevalence of bone loss in lower permanent premolars and canines, which can serve as abutments for future prostheses, among diabetic and non-diabetic patients. Materials and Methods: In this retrospective case-control study, records of patients who visited the dental clinics of Imam Abdulrahman Bin Faisal University were used. Inclusion criteria were the presence of a complete periodontal chart, full mouth radiographs, and past medical history (presence of DM, hypertension, and/or coronary heart disease). The criteria for exclusion were the reporting of malignancy, pregnancy, breastfeeding, or taking of the medications that affect bone turnover, periodontal surgery within the past year, absence of radiographs with good quality, and antibiotic use within 3 months prior to the dental visit. Demographical data, including gender and age, past medical history (diabetic state), and periodontal diagnosis, were collected. The severity of periodontal disease, radiographic bone loss (RBL), and its pattern were also assessed. Results: Out of 400 records, 363 patient files were included. Of those, almost 36% were males and 64% were females. The patients’ age was ranging from 16 to 82 years. About 34% of the patients were diagnosed with generalized periodontitis while 22% had localized periodontitis. With regards to the severity of the cases, the prevalence was equally distributed between mild (37%) and moderate periodontitis (38%), while 25% were diagnosed with severe periodontitis. A total of 22% of the patients were diabetic, which showed an increase in the severity of bone loss by an average of 31% across the selected teeth (mandibular canines and premolars). The pattern of bone loss was higher in the mandibular incisors, followed by the canines and the premolars. Multiple regression models showed that non-diabetics were significantly less likely to have bone loss in all the selected teeth and the male patients had 2 times the likelihood of having bone loss. Although the mandibular canines have the highest root length in the mandible, they were the most affected by bone loss in diabetic patients with periodontitis. Conclusion: Results of this study suggested that mandibular premolars were the teeth least affected by bone loss in both, diabetic and non-diabetic groups. Therefore, they can be considered the most suitable teeth to be used as abutments for the future prosthesis.

In this preclinical two-dose mucosal immunization study, using a combination of S1 spike and nucleocapsid proteins with cationic (N3)/or anionic (L3) lipids were investigated using an intranasal delivery route. The study showed that nasal administration of low amounts of antigens/adjuvants induced a primary and secondary immune response in systemic IgG, mIL-5, and IFN-gamma secreting T lymphocytes, as well as humoral IgA in nasal and intestinal mucosal compartments. It is believed that recipients will benefit from receiving a combination of viral antigens in promoting a border immune response against present and evolving contagious viruses. Lipid adjuvants demonstrated an enhanced response in the vaccine effect. This was seen in the significant immunogenicity effect when using the cationic lipid N3. Unlike L3, which showed a recognizable effect when administrated at a slightly higher concentration. Moreover, the findings of the study proved the efficiency of an intranasally mucosal immunization strategy, which can be less painful and more effective in enhancing the respiratory tract immunity against respiratory infectious diseases.

Hospital-acquired infections (HAIs) contribute to increased length of hospital stay, higher mortality and higher health-care costs. Prevention and control of HAIs is a critical public health concern. This study assessed the knowledge, attitude, and practice (KAP) of standard infection control precautions among health-care workers (HCWs) in Qassim, Saudi Arabia. A cross-sectional online survey among HCWs was conducted using a structured questionnaire. Predictors of KAP were investigated using multivariate logistic regression analyses and independent sample t-tests. A total of 213 HCWs participated in the survey. The prevalence of good (≥80% correct response) knowledge, attitude, and practice were 67.6%, 61.5%, and 73.2%, respectively. The predictors of good knowledge included the age of the HCWs (&gt, 34 years) (adjusted odds ratio: 30.5, p &lt, 0.001), and training (13.3, p &lt, 0.001). More than 6 years of work experience was a significant predictor of having a positive attitude (5.5, p &lt, 0.001). While the predictors of good practice were having &gt, 6 years of experience (2.9, p &lt, 0.01), previous exposure to HAIs (2.5, p &lt, 0.05), and training (3.5, p &lt, 0.01). However, being female (0.22, p &lt, 0.001) and older (&gt, 34 years) (0.34, p &lt, 0.01) were negatively associated with knowledge. Results indicate that arranging training for HCWs might be useful in improving their knowledge of standard infection control precautions and is also expected to facilitate positive attitude and practice.

Aim: This meta-analysis and systematic review aim to investigate and compare the efficacy of mannitol and hypertonic saline in treating patients who have suffered from traumatic brain injury. Methods: We reviewed publications from the Medline database, Web of Science, and Google Scholar from inception to 13th October 2022 with only English-based literature. The risk of bias from included RCTs was assessed using the Cochrane Collaboration's Tool. Newcastle-Ottawa Scale (NOS) was employed to assess the included cohort's quality. The main outcomes of this review were treatment failure, mortality, ICP reduction and CPP increment. All the statistical analyses were performed using the Review Manager 5.4.1. A random-effects model was used to pool the studies when heterogeneity was seen, and the results were reported in the Odds Ratios (OR) and Mean Differences (MD) and the corresponding 95% Confidence Intervals (CI). Results: The results of the statistical study found that there was a significantly lower treatment failure rate (OR = 1.80 [1.26, 2.57]; p = 0.001; I2 = 74%), the lower mortality rate (OR = 2.17 [1.26, 3.73]; p = 0.005; I2 = 0%), a greater increase in CPP (MD = -1.28 [-2.50, -0.05]; p = 0.04; I2 = 0%) associated with hypertonic saline treatment as compared to mannitol treatment. However, concerning ICP decrease, there was no significant difference between the two treatment options. (MD = 1.86 [-0.64, 4.36]; p = 0.14; I2 = 70%). Conclusions: Quantitative and qualitative analysis of trials and observational studies comparing the efficacy of hypertonic saline and mannitol demonstrates that hypertonic saline is a preferable treatment option with greater effectiveness and safety than mannitol in managing patients with traumatic brain injury.

Background: Geographical variation may affect the phytochemistry as well as the biological activities of Glycyrrhiza glabra (licorice) root. Herein, a series of biological activities were performed to evaluate the impact of geographical origin on the biological potential of eight different licorice samples. Methodology: Cell culture studies were performed for cytotoxicity (MCF7, HCT116, HepG2, and MRC5), glucose uptake assay (HepG2), and glutathione peroxidase activity (HepG2), whereas α-amylase inhibition activity was tested for antidiabetic potential. Results: The Indian sample was observed to be more cytotoxic against MCF7 (22%) and HCT116 (43%) with an IC50 value of 56.10 (±2.38) μg/mL against the MCF7 cell line. The glucose uptake was seen with a mean value of 96 (±2.82) and a range of 92–101%. For glutathione peroxidase activity (GPx), the Syrian (0.31 ± 0.11) and Pakistani samples (0.21 ± 0.08) revealed a significant activity, whereas the Palestinian (70 ± 0.09) and Indian samples (68±0.06) effectively inhibited the α-amylase activity, with the lowest IC50 value (67.11 ± 0.97) μg/mL for the Palestinian sample. The statistical models of PCA (principal component analysis) and K-mean cluster analysis were performed to correlate the geographical origin, extract yield, and biological activities for the eight licorice samples of different origins. Conclusion: The licorice samples exhibited significant cytotoxic, GPx, and α-amylase inhibitory activity. The samples with higher extract yield showed more potential in these biological activities.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is RNA virus, responsible for coronavirus disease 2019 (COVID-19), which has now taken the form of a pandemic. Even though the world has undertaking all possible measures to impede the spread of this droplet infection, still the prevalence of COVID-19 is on the rise and has infected more than 208 countries all over the globe. Reviewing the website and global articles from PubMed, Scopus and other cites on COVID-19 a global pandemic, this review article provides an update on the all major aspects of coronavirus such as origin, epidemiology, mode of transmission, structure and molecular characterization, characterization of spike protein, clinical features including cutaneous manifestation, radiological features, molecular testing, histopathology and the current preventive approaches. Importantly, review also provides an update on current projections of Saudi Arabia on COVID-19 pandemic.

Purpose Melanotic schwannoma (MS) was formerly known as a rare variant of schwannoma. The behavior of MS is unpredictable, with a tendency for recurrence and metastasis. The purpose of this study was to illustrate the imaging characteristics of these rare and misdiagnosed tumors. The prognosis of MS is discussed, along with the importance of follow-up exams to assess for recurrence and metastasis. Furthermore, we compare our results with those previously published on MS in order to have a better understanding of this rare entity. Methods Three MS cases were encountered between 2008 and 2015 at our institute. All available data were reviewed, including the clinical history, imaging findings, operative notes, and the histopathology results. A follow-up magnetic resonance imaging (MRI) scan was also reviewed up to 23 months post surgery to assess for recurrence. Results Three cases of MS are included: one in the brain and two in the spine. The brain lesion was in the occipital region. The spine lesions were thoracic intramedullary and sacral intradural. All cases were hypointense on T2-weighted imaging. Gross total resection was achieved for all lesions without adjuvant therapy. To date, the brain lesion recurred 15 months after surgery. Conclusions MS is a rare and distinct entity rather than a variant of schwannoma, and it poses both diagnostic and management dilemmas. Although MS has characteristic MRI features, including T1 and T2 shortening, the preoperative diagnosis is always challenging. Accurate diagnosis is crucial for management planning, including long-term follow-up exams to assess for recurrence and metastasis.

Background The COVID-19 pandemic has impacted education in myriad ways, primarily leading to an abrupt paradigm shift in teaching and learning practices towards distance learning. The study aims to assess the effectiveness of teaching radiology to undergraduate medical students using synchronous distance learning compared to traditional on-campus learning through exploring students’ perceived satisfaction and concerns. Students’ perceptions were correlated with their attendance, grades, and frequency of technical difficulties. Methods The study was designed as an observational study involving fourth-year medical students (2019/2020) from two institutions. The cohort students were exposed to traditional learning, distance learning, or both. Students completed an online self-administered questionnaire concerning their perceptions of distance learning. Students’ attendance, engagement, technical difficulties, and post-clerkship knowledge assessments were analyzed using descriptive and inferential statistics. Results A total of 145 participants completed the clerkship using the following strategies: traditional learning (n = 66), both traditional and distance learning (n = 67), and distance learning alone (n = 12). The most important result indicates that the abrupt transition to distance learning was well perceived. Most students preferred distance learning over traditional learning in the radiology clerkship (p = .05). During the synchronous sessions, student attendance was high, reaching to 100%. Technical difficulties were limited (1.9%), and they did not affect learning. Conclusion Synchronous distance teaching promotes learning, interaction, and enjoyment in undergraduate radiology education, and it can be as effective as traditional on-campus learning. The technical difficulties encountered, although they were limited, can be overcome by recording the synchronous sessions.

Background: Irritable bowel syndrome (IBS) is a complex functional disorder of the gastrointestinal tract that constitutes a major portion of the total outpatient visits to gastroenterologists and other healthcare professionals. The cardinal symptom of irritable bowel syndrome is chronic abdominal pain with altered bowel habits in the absence of a discernable organic disease. This chronic disorder is highly prevalent and seen in as many as 10-20% of the entire population. Several treatment options are available for IBS which have progressed and evolved rapidly with the introduction of several new guidelines. Objectives: In this review we aim to shed light on the available treatment options for irritable bowel syndrome including patient education, lifestyle modifications, dietary changes and the currently employed pharmacologic agents. Materials and Methods: A review of relevant articles published from 1984 till date in English language was done using the electronic databases of PubMed Pico and, Google Scholar with preset keywords. Keywords: Irritable bowel syndrome, abdominal pain, constipation, diarrhea, lifestyle changes, dietary modifications, pharmacotherapy, and physical therapy. Conclusion: A multidisciplinary approach is recommended for the treatment of IBS. This includes collaboration of a team consisting of primary-care physician, a psychiatrist, a dietician, and a nurse practitioner. Following diagnosis of Irritable bowel syndrome, it is essential to establish a strong physician-patient relationship and enforce continuity of care given the chronicity of symptoms of Irritable bowel syndrome. In addition to the various pharmacologic agents available, it is mandatory to express empathy, encourage patient participation and promote lifestyle changes. Physical activity and dietary modifications can be greatly beneficial and should be tailored to the need of the individual patient. Pharmacology should focus on the predominant symptom and address them specifically such as constipation, diarrhea and abdominal pain.

Background: Parsley (Petroselinum crispum L) (PAR) is used widely as an antioxidant, antihyperlipidemic, diuretic, and medication to reduce hypertension. At the same time, conventional drugs such as Simvastatin (SV) are also used to manage hyperlipidemia in hypertensive patients. However, no studies have reported any interactions for the concomitant use of PAR and SV. Objectives: The study aimed to evaluate the enzyme-inducing or inhibiting role of PAR for SV at the level of cytochrome P-450 metabolic enzyme. Methods: This is an open-label (unblinded) study conducted with 24 healthy albino rats (4X6 = 24), at Imam Abdulrahman Bin Faisal University, Saudi Arabia, in the year 2018 with protocol approval No. IRB-2018-145-Pharm and approval date 18/04/2018. The animals were administered with a loading single oral dose of SV (80 mg), Clarithromycin (CLAR; 80 mg), Carbamazepine (CBZ; 80 mg), and PAR, i.e., dried herb powder (200 mg), in order to achieve a steady state concentration in the blood. Blood samples were collected at specified time points including pre-dose (0.0) and after-treatment, i.e., 0.5, 1, 1.5, 2, and 3 hours, and centrifuged. The plasma was extracted to analyze for SV by LC-MS using a previously developed method. Results: The analysis of pharmacokinetic parameters revealed enhanced Cmax (mean plasma maximum concentration) and AUC0-∞ (area under the concentration-time curve) as 2 and 2.2 folds, respectively, for SV+PAR (P < 0.01) as compared to SV alone. A decrease in CL/F (total-body clearance of drug from the plasma) for SV (P < 0.01) and an increased t1/2 (mean half-life) from 3.20 to 6.12 hours for SV co-administered with PAR were observed. Conclusions: Parsley combined with Simvastatin increased the Cmax and AUCs for Simvastatin as 2 and 2.5 folds; thereby, the moderating enzyme-inhibiting role of Parsley for CYP 3A enzyme may be proposed. Hence, caution is required when administering Parsley with Simvastatin for any therapeutic purpose.

This article has answered on two questions; what the process-outcome weight ratio for oriented outcome should be? The second question is: What are the items would be reflected elements under dimensions of both sides? In logic thinking, the used corporate social responsibility (CSR) dimensions of Islamic banks (IBs) have different impacts on the society as result for that these dimensions should be different. There still is very lack in using appropriate weights of dimensions to measure of CSR in IB. By redistribution of the dimensions to two types; business process dimensions (BPDs) and oriented outcome dimensions (OODs) then give each type specific weight to suit their consequence on the CSR’s level in IBs. From 115 items, 23 sub-dimensions, and 7 dimensions that have taken from 18 articles since 2005 until 2013, this article has selected 16 items, 9 sub-dimensions, and 5 dimensions. Only Mohammed et al. (2008) built an index has different weights of the CSR’s dimensions based on several academic experts in IB. The dimensions’ weights has been calculated based on weights of Mohammed et al (2008) in which ratio of BPDs and OODs has been 54 and 46 respectively.

There are some academic efforts that have tried to measure corporate social responsibility (CSR) in Islamic banks (IBs) practices. But there is very lack in measuring the CSR of IBs through their operations not through their oriented outcomes. This article has suggested Musharakah and equity as new items to fill the important gap in measuring field of IBs’ CSR. In this work, the Musharakah is social and economic tool in IB finance and it is for the customers. Whilst the equity is a type of investments in IBs, in which the bank is as shareholder in other business organizations. It is coming from the deeper understanding of Shari’ah principles (Maqasid Shariah) in Islamic business world. With both cases (Musharakah with customers or equity with investors) IBs will share other in loss and profit and they are more far from Riba (interest rate) as in conditional banks. Not enough that IBs are undergo for Islamic law (Fiqhi) to reach the best level of CSR but they should have investments and financing that based on broad utility for the society. That is not mean that oriented-outcome side is not important of the IB’s CSR.

Squamous cell carcinoma (SCC) of the kidney is a rare entity. Coexistence of SCC with xanthogranulomatous pyelonephrits is exceedingly rare with only few reports in the literature. We report a case of a 45-year-old male patient with xanthogranulomatous pyelonephritis coexistence with renal SCC in one kidney, which proved radiologically and histopathologically. The patient presented to the medical care with bone metastasis. Full radiology workup is also provided which includes computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography. Keywords: Renal squamous cell carcinoma, Xanthogranulomatous pyelonephrits, Bone metastasis

Upper gastro intestinal bleeding is one of the most common reasons of emergency department visits, totaling up to 400,000 annual admissions in the United States. Peptic ulcer disease and variceal bleeding are two of the most common causes of GI bleeding. Several studies have been done, and major advancements were made in its management leading to significant drop in morbidity and mortality. Our aim is to study the common causes of upper gastrointestinal bleeding that come to the emergency department and understand the latest guidelines to manage them. We conducted this review using a comprehensive search of PubMed, MEDLINE, and EMBASE from March 1981, through November 2017. The following search terms were used: upper gastro intestinal bleeding, management of upper GI bleeding, variceal bleeding, peptic ulcer bleeding, hemorrhage in the emergency department. Acute upper gastrointestinal bleeding is one of the most common cases encountered in the emergency department and leading to significant morbidity and mortality. Clearing airway and breathing and stabilizing the vitals of the patient by achieving hemodynamic stability and bleeding control is the primary goal in the emergency department.

Estimates say that Helicobacter pylorus affects more than half of the general population over the world. Its prevalence varies significantly among different areas. Studies done in 1990 reported a prevalence of 70% of people older than 20 years who live in Saudi Arabia, and 40% of people aged 5-10 years. The first line regimen of helicobacter pylori infections in Saudi Arabia is 7 days of triple therapy. However, in areas of high antibiotic resistance, or in cases of failure of triple therapy, a ‘rescue’ quadruple therapy (that contains bismuth) is indicated. In this study we aimed to look at the prevalence of H. pylori infection and its association with gastroesphageal reflux disease in Saudi Arabia. We also tried to understand the approach for diagnoses and treatment in the Kingdom. We did a systematic search for helicobacter pylori and GERD in Saudi Arabia using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). The following search terms were used: H. pylori, gastroesophageal reflux disease, prevalence of GERD in Saudi Arabia, lifestyle Saudi Arabia, gastroenterology Saudi Arabia. All studies done shows prevalence in Saudi Arabia to be relatively high (reaching 70%) and increasing. Despite being highly prevalent, no solid guidelines are present to help clinicians diagnose and treat helicobacter pylori infection properly. These, along with other causes like improper use of antibiotics have led to the emerging of new strains that are resistant to typical antibiotic treatment.

Hydatid cyst of the breast is endemic in some areas like sheep-raising countries. The location of the disease is mostly in the liver and lungs. We presents a case of 66-year-old female with hydatid cyst of the breast diagnosed pre-operatively by core needle biopsy. Complete radiology workup are also provided which includes mammography, ultrasound, and computed tomography images. Hydatid cyst of the breast is extremely rare even in endemic areas, its only accounts for 0.27% of all cases. Only few reports are published in the literatures about breast hydatid cyst and majority of cases have been diagnosed post-operatively with no complete radiology workup.Pan African Medical Journal 2013; 14: 99

Renal cell carcinoma (RCC) is encountered in about 3% of all adult neoplasms. Presence of any kidney malformation can change the plan for surgical treatment of RCC with organ preserving surgery. We report a case of clear cell RCC in a horseshoe kidney. Computed tomography scan revealed a horseshoe kidney anomaly with a large mass in the left side. The diagnosis of RCC was confirmed by pathology and histology findings.