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Power dispatch has become an important issue due to the high integration of Wind Power (WP) in power grids. Within this context, this paper presents a new Particle Swarm Optimization (PSO) based strategy for solving the stochastic Economic Emission Dispatch Problem (EEDP). This problem was solved considering several constraints such as power balance, generation limits, and Valve Point Loading Effects (VPLEs). The power balance constraint is described by a chance constraint to consider the impact of WP intermittency on the EEDP solution. In this study, the chance constraint represents the tolerance that the power balance constraint cannot meet. The suggested framework was successfully evaluated on a ten-unit system. The problem was solved for various threshold tolerances to study further the impact of WP penetration.

Objectives: To investigate the degree of public awareness, beliefs, and attitudes regarding major depression and available treatment options in the Saudi population. Methods: A community-based cross-sectional study of 1,188 participants was carried out from March to April 2021 in Ha’il, Saudi Arabia using an online self-administered questionnaire. Using a snowball sampling technique, the authors targeted the Saudi population living in Ha’il region. Results: Overall, 65.6% of the participants had good awareness regarding depression disorder in total. Of the participants, 72.9% had good awareness regarding general awareness, 85.4% regarding depression symptoms, 12.3% regarding risk factors, and 15.7% regarding treatments. Of the participants, 67.3% believed that depression was caused by lack of faith and 45.5% believed that depression was caused by “the evil eye” or black magic. Of the participants, 56% believed in faith healers as a legitimate treatment approach. Of the participants, 63.9% were willing to work with individuals with depression, 62.7% were willing to establish friendships with them, and 27.9% believed that individuals with depression had weak personalities. Conclusion: The general population exhibited good general awareness regarding depression and its symptoms, but knowledge of risk factors and treatments was poor. Our findings underscore the need for public educational programs to increase public awareness about the risk factors and treatment options for depression.

Objective: The purpose of the survey was to gather information from students on their learning preferences prior to the COVID-19 outbreak, barriers to online education during the pandemic, and the mental and psychological effects of COVID-19 on students. Method: Applying Google Forms, a cross-sectional pharmacy student-targeted online questionnaire designed to develop. In order to ensure that only pharmacy students responded, an introductory opening inquiry of the program name used to select out non-pharmacy students. Following that, these few demographic questions are asked to the participant's present institution and program year in which the participants currently in. Results: A total 260 pharmacy students received the survey, out of total 186 replies were received from professional pharmacy students, resulting in a response rate of around 71.5%. Almost half of the students (94%) chose traditional face-to-face training, while 32.8% preferred a combination of online and face-to-face instruction, and only 16.7% liked online instruction alone. The difficulties to online education during the COVID-19 pandemic outbreak show that, Issues with in-person communication (23.7%), pandemic-related anxiety and stress (22%), time management (19.9%), experience in online education (16.7%). The majority of respondents (87%) intended to incorporate online knowledge gained during the COVID-19 pandemic outbreak into their teaching/learning techniques. During the COVID-19 epidemic, we discovered that practically all students were plagued by symptoms of sadness, anxiety, tension, and poor sleep quality, with the majority suffering from significant depression (31.2 %). Conclusion: This study concludes that most of the students are in favor of incorporation and applications of online learning experiences in teaching/learning practices garnered during pandemic. Furthermore, the majority of students had changed their behavior as a result of coronavirus, while nearly half of those polled experiencing an increase in anxiety and tension. Keywords: COVID-19 pandemic, online learning, mental health, Pharm.D students, Pharmacy education, face to face learning.

Interferential current is one of the most common electrotherapeutic modalities used in the treatment of painful conditions. Patients seeking medical help to reduce their musculoskeletal pain can be treated using interferential current.The current review aimed to analyze the recently available information regarding the efficacy of interferential current in alleviating the pain of musculoskeletal origin.This study used Scopus, CINAHL, Cochrane Library, Web of Science, MEDLINE, Embase, and EBSCOas as data sources. The initial selection of the studies, thorough assessment of the full articles, and extraction of the necessary study characteristics were carried out by two independent reviewers. Another two independent reviewers assessed the methodological quality of each included trial against 39 criteria. These criteria were integrated from several popular scales. Pain intensity-measured using the visual analog scale, numeric pain rating scale, or McGill Pain Questionnaire-was the outcome of interest.This review included 35 trials of variable methodological quality from which 19 trials were selected for the meta-analysis. In general, interferential current alone versus placebo demonstrated a significant pain-relieving effect. On the other hand, interferential current showed no significant difference when added to standard treatment compared with placebo plus standard treatment or standard treatment alone. Similarly, interferential current showed no significant difference when compared with other single interventions (laser, transcutaneous electrical nerve stimulation, cryotherapy).Interferential current alone is better than placebo at discharge. However, the low number of studies raises suspicions about this conclusion. Interferential current alone or added to other interventions is not more effective than comparative treatments in relieving musculoskeletal pain.

Background: Alzheimer’s disease is a nervous system destructive disease which causes structural, biochemical and electrical abnormalities inside the human brain and results due to genetic and various environmental factors. Traditional therapeutic agents of Alzheimer’s disease such as tacrine and physostigmine has been found causing adverse effects to the nervous system and gastrointestinal tract. Nanomaterials like graphene, metals, carbon-nanotubes and metal-oxides are gaining attention as potential drugs against Alzheimer’s disease due to their properties such as large surface area which provides clinical efficiency, targeted drug designing and delivery. Objectives: Designing new drugs by using experimental approaches are time-consuming, tedious and laborious processes which also require advanced technologies. This study aims to identify the novel drug candidates against Alzheimer’s disease with no or less associated side effects using molecular docking approaches. Methods: In this study, we utilized nanoinformatics based approaches for evaluating the interaction properties of various nanomaterials and metal nanoparticles with the drug targets including TRKB kinase domain, EphA4 and histone deacetylase. Furthermore, drug-likeness of carbon nanotubes was confirmed through ADME analysis. Results: Carbon nanotubes, either single or double-walled in all the three-configuration including zigzag, chiral, and armchair forms are found to interact with the target receptors with varying affinities. Conclusion: This study provides a novel and clearer insights into the interaction properties and drug suitability of known putative nanoparticles as potential agents for the treatment of Alzheimer’s disease.

Aim This study aimed to examine the social stigma experienced by healthcare workers caring for people diagnosed with COVID-19. Methods This research employed a qualitative-phenomenological approach. It was conducted at the COVID centers of the Hail region, Kingdom of Saudi Arabia. Both purposive and snowball sampling were used, resulting in 15 participants. However, saturation was identified in the 11th participant. Interviews were conducted online through a Zoom platform, with at least 50 min per participant. Thematic analysis was used in analysing the data. Results The nurses recorded four themes and three subthemes based on one-on-one interviews. These themes included (1) Labeling nurses as “COVID Nurses,” with a subtheme of frustration, (2) “Fear of the unknown,” with a subtheme of “uncertainties,” (3) Nurses’ need for support, and (4) the Love for the profession, with a subtheme of “nurses’ worth.” Conclusion Nurses who cared for patients diagnosed with COVID-19 experienced stigma. They were labeled “COVID Nurses.” They experienced fear of the unknown and uncertainties and felt they needed support. Despite these experiences, the nurses felt fulfilled as they have a high regard for their profession. The experiences of these nurses call for intervention to help them before, during, and after any health-related crisis. In this context, nurses will be prepared mentally and emotionally to face the challenges in their career.

The global prevalence of DM is steadily increasing. Depression in patients with diabetes is more prevalent than in the general population. There is good evidence. The bidirectional link can be between diabetes and depression. The chronic nature of the illness and its various consequences can lead to depressive diabetes patients, while increased counter-rulatory hormones can cause the development of diabetic syndromes. Social and environmental variables which influence self-care burden patients and their families substantially. It can lead to depression. Depressed people with diabetes also may experience poor health, inadequate income, stigma and a lack of social support. The aim of the present study is to summarize previously estimated prevalence of depression in patients diagnosed with T2DM, and to identify sociodemographic, clinical and psychological factors associated with the occurrence of depression in diabetic patients in Saudi Arabia and worldwide.

The coronavirus disease 2019 (COVID-19) infection has emerged lately, leading to a serious public health threat. The clinical features associated with COVID-19 are yet to be conclusively documented. Caution is needed when interpreting the severity of the symptoms as most of the diagnosed patients are those attending clinical assessments. Features of COVID-19 are far from understood. There is a suggested increased risk of COVID-19 infection among people with mental health disorders, which is primarily attributable to the challenges associated with limited resources. There are a variety of reasons why individuals with mental health disorders are more susceptible to infectious diseases. There is currently no specific recommended antiviral treatment. The interventions now used are supportive treatments to alleviate the symptoms and invasive mechanical ventilation. In this review, we discuss the adverse events associated with COVID-19 vaccinations. We further highlight the need to develop guidelines and recommendations for managing patients with mental health. It is evident from this review, there is a need to provide training programs with interprofessional, multidisciplinary communication channels.

Introduction Two main factors have a great influence on the youth's oral well-being. These are their dental health and age. These two factors are significantly directed by parents through establishing a system of proper oral hygiene and a preventative routine for those young adults. Aim and objective The following study was run in the Dammam region, Saudi Arabia, to assess guardian awareness of youngster's dental health. Materials and methods This community-based study was designed in a cross-sectional pattern, where a sample size of 248 parents who fulfilled inclusion criteria was selected and a well-designed validated questionnaire was used for the collected database using SPSS (VER. 24). Results The main found included that, about 51% of participants were fathers and 49% were mothers, 90% of them above the age of 26 years old and most of the participants had a secondary certificate or university degree, 38% and 45%, respectively, only 64% of parents have checked their children teeth, the average of overall knowledge of parents toward dental health was medium 7.97 points out of 16.0 points and there was a statistically significant relationship between parents type, educational level, and overall knowledge related to oral health. Conclusion From our study, it was acknowledged that the perception of children's oral health status by their parents in the Dammam region is relatively medium, so general awareness of parents' knowledge should be raised by conducting effective oral health programs and interventions. How to cite this article Alshammari FS, Alshammari RA, Alshammari MH, et al. Parental Awareness and Knowledge toward their Children's Oral Health in the City of Dammam, Saudi Arabia. Int J Clin Pediatr Dent 2021;14(1):100-103.

This study presents a metaheuristic method for the optimum design of multimachine Power System Stabilizers (PSSs). In the proposed method, referred to as Local Search-based Non-dominated Sorting Genetic Algorithm (LSNSGA), a local search mechanism is incorporated at the end of the second version of the non-dominated sorting genetic algorithm in order to improve its convergence rate and avoid the convergence to local optima. The parameters of PSSs are tuned using LSNSGA over a wide range of operating conditions, in order to provide the best damping of critical electromechanical oscillations. Eigenvalue-based objective functions are employed in the PSS design process. Simulation results based on eigenvalue analysis and nonlinear time-domain simulation proved that the proposed controller provided competitive results compared to other metaheuristic techniques.

Faizah M Alshammari,1 Entisar J Alanazi,1 Afnan M Alanazi,1 Abdulrahman K Alturifi,2 Thamir M Alshammari3,4 1Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia; 2Department of Infection Prevention and Control, Hail Health Affairs, Ministry of Health, Hail, Saudi Arabia; 3Department of Pharmacy Practice, College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia; 4Medication Safety Research Chair, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Thamir M AlshammariDepartment of Pharmacy Practice, College of Pharmacy, Riyadh Elm University, P.O. Box 2457, Riyadh, 11451, Saudi ArabiaTel +966 505192886Email Thamer.alshammary@gmail.comBackground: Medication errors pose a risk for individual patients and for public health, with the misuse and overuse of medications being linked to severe patient safety problems. Therefore, the objective of this study was to investigate healthcare professionals’ (HCPs’) knowledge about medication errors, their knowledge about medication error reporting systems, and predictors for HCPs to report medication errors in Saudi Arabia.Methods: An observational cross-sectional study was conducted among HCPs (physicians, pharmacists, and nurses) between January and March 2020. The study included 6 distinct locations in the Saudi Arabian regions of Hail, Al-Qassim, Al-Jouf, Al-Madinah, the eastern region, and the western region. Descriptive statistical and inferential analyses were computed using Statistical Package for the Social Sciences (SPSS) v.22.Results: In total, 980 questionnaires for 348 (35.5%) physicians, 144 (14.7%) pharmacists, and 488 (49.8%) nurses were distributed with a response rate of 100%. Interestingly, only 277 (28.3%) of the HCPs had a good understanding of the stages of medication errors. With regard to reporting practices, a high number of the HCPs, 576 (58.8%), had not reported medication errors in their workplaces, and nearly 369 (37.7%) of respondents said they believe that legal implications are a major barrier to the reporting of medication errors. More than half, 524 (53.5%), of HCPs revealed that no clear electronic system is available for the reporting of medication errors in most hospitals. In addition, 537 (54.8%), of the HCPs had not attended any training programs regarding medication error reporting systems within the past year, which is alarming.Conclusion: Our study identified a huge lack of the reporting of medication errors, knowledge about medication error stages, and training on medication errors. Therefore, an urgent need to address these weaknesses exists.Keywords: medication errors, knowledge and attitude, healthcare professionals, patient safety, Saudi Arabia

BackgroundSince December 2020, three COVID-19 vaccines have been authorized in the United States (U.S.) and were proceeded by large immunization programs. The aim of this study was to characterize the U.S. post-marketing safety (PMS) profiles of these vaccines with an in-depth analysis of mortality data.MethodsThis was a retrospective database analysis study. Details of the U.S. PMS reports (15 December 2020 to 19 March 2021) of the three vaccines (Pfizer-BioNTech, Moderna, and Janssen Ad26.COV2.S) were retrieved from the U.S. Vaccine Adverse Event Reporting System (VAERS). A descriptive analysis was conducted to characterize the reported adverse events (AEs). A comparative (Pfizer-BioNTech vs. Moderna) analysis of mortality was conducted. The mean count ratio of death between the two vaccines was estimated using a negative binomial regression model adjusting for the measured confounders.ResultsA total of 44,451 AE reports were retrieved (corresponding to 0.05% of the U.S. population who received at least one dose). The most commonly reported AEs were injection site reactions (30.4% of the reports), pain (reported in 26.7% of the reports), and headache (18.6% of the reports). Serious AEs were reported in only 14.6% of the reports with 4,108 hospitalizations. The total number of deaths was 1,919 with a mean count ratio of Moderna (n=997) vs. Pfizer-BioNTech (n=899) of 1.07 (95% confidence interval 0.86 to 1.33).ConclusionsThe vast majority of PMS AEs in the U.S. were non-serious, and the number of serious AEs is very low given the total number of vaccinated U.S. population.

BackgroundThe rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU).MethodsThe SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations.ResultsThe SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. ConclusionThe SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.

Background: Congenital diaphragmatic hernia (CDH) is an anatomical defect of the diaphragm, which allows protrusion of abdominal viscera into the chest, causing serious pulmonary and cardiac complications in the neonate. Objective: In this case report we aimed to present a rare case of late presentation of congenital diaphragmatic hernia. Patient and method: We reported a late diagnosis of CDH at age of 3 months, who was referred to our center as a persistent left sided chest infection that needs necessarily intervention. Result: At this late-presenting patient, which could be due to small defect in the diaphragm and could be missed antenatally or even in early postnatal period, it is expected to get worse when bowel distended, or patient stressed. Management of this condition was explored in detail, survival and prognostic factors were addressed. Conclusion: CDHs are still a diagnostic challenge. Some are still missing in our community, and we need to improve medical services starting from antenatal visit. CDH should be kept in mind as a potential differential diagnosis in early infancy period for any patient presented with respiratory distress.

Ever since the pandemic started in March 2020, the whole world and the healthcare system were overburdened with an extremely difficult task of curbing COVID-19 as much as possible to decrease the death rate and to understand its effects. Diabetic patients are no different as they constitute a large group globally. Therefore, understanding the biggest factors that affects their day-to-day life is crucial to be able to treat them well and decrease the chances of having high mortality rates among diabetics. COVID-19 in diabetes is susceptible to high mortality rates making them prone to develop nutritional and psychological effects. Further studies are needed to provide better care in the future for diabetic patient’s psychological and nutritional wellbeing and alleviate their healthcare by developing targeted programs, awareness and scheduled home visits.

Cancer patients are considered one of the most vulnerable to infection with Corona virus (COVID-19), especially who are elderly, multiple comorbidities, and are often immunosuppressed by their cancer or therapy. The immune system of cancer patients is very weak compared to the healthy individuals, so, morbidity and mortality of any serious infections expected to be high among them. This research aims to study the impact of COVID-19 pandemic on cancer patients practices in Saudi Arabia (KSA) and compare with the result in Egypt. It was conducted through a well-structured questionnaire, among cancer patients either online (KSA) or paper questionnaire (Egypt). The questionnaire consists of 16 questions about Scio-demographic and changes in time and method of treatment (chemotherapy and radiotherapy), postponed of surgical operations. Our results showed significant differences between KSA and Egypt hospital practices; cancer department was affected by postponed appointment (54.8% & 63.3%), diagnosis (32.7% & 60%) and treatment of cancer patients (37.1% & 63.3%) respectively. Also, postponed of chemotherapy/radiotherapy (56.8% & 73.3%), surgical operations (45% & 43.3%), an increase in the deterioration of cancer by (35.5% & 23.3%), switching from parenteral injection to oral (27.8% & 56.7%) and changing in the drug doses (19.5% & 40%) in KSA and Egypt respectively. We can conclude that management of cancer patients during COVID-19 pandemic of great importance and so, switching from parenteral to oral, prolongation of the treatment period and postponed of some surgical operations gave a good opportunity to maintain adequate care of cancer patient with minimum exposure of patients to infection.

We conducted the current analysis to determine the potential role of polio vaccination in the context of the spread of COVID-19. Data were extracted from the World Health Organization’s (WHO) Global Health Observatory data repository regarding the polio immunization coverage estimates and correlated to the overall morbidity and mortality for COVID-19 among different countries. Data were analyzed using R software version 4.0.2. Mean and standard deviation were used to represent continuous variables while we used frequencies and percentages to represent categorical variables. The Kruskal-Wallis H test was used for continuous variables since they were not normally distributed. Moreover, the Spearman rank correlation coefficient (rho) was used to determine the relationship between different variables. There was a significantly positive correlation between the vaccine coverage (%) and both of total cases per one million populations (rho = 0.37; p-value < 0.001) and deaths per one million populations (rho = 0.30; p-value < 0.001). Moreover, there was a significant correlation between different income groups and each of vaccine coverage (%) (rho = 0.71; p-value < 0.001), total cases per one million populations (rho = 0.50; p-value < 0.001), and deaths per one million populations (rho = 0.39; p-value < 0.001). All claims regarding the possible protective effect of Polio vaccination do not have any support when analyzing the related data. Polio vaccination efforts should be limited to eradicate the disease from endemic countries; however, there is no evidence to support the immunization with live-attenuated vaccines for the protection against COVID-19.

Water scarcity is a big challenge in many countries including Saudi Arabia, for which solar water desalination is a strategic goal due to the high solar intensities and the long sunshine duration. The main objective of this study is to develop a low cost and high efficiency solar water desalination device for small communities and remote areas in Saudi Arabia. The study is conducted in December 7th, 2020 (winter season) under the climatic conditions of Ha'il city (27.66 oN, 41.72 oE), Saudi Arabia. An inclined solar still was designed with a black cotton wick and a continuous saline water circulation flow via a small pump. Results showed high device performance with low freshwater production cost. The device is able to produce 3.21 L/m2day with 50.55% thermal efficiency and $0.0118/L cost of freshwater yield. Also, the device productivity is expected to be higher in the summer season. The proposed device has a significant low cost of $76.5/m2 which can be very attractive in the solar desalination market. The developed device increases the efficiency and productivity by 139.12% and 21.13%, respectively, and lowered the freshwater production cost by 57.86% compared with the device without the wick.

The safety of cloud services within a Trust Model System (TMS) is certainly compromised by a lack of defense against security threats as well as by inaccuracy of the trust results. Our proposed model addresses well-known security threats to the reputation trust model system, and is shown to deal with all possible potential attack threats, such as Sybil, on–off, and collusion attacks, by specifying the identity of users and tracking activities undertaken by them in order to easily track unauthorized consumers or attackers and to provide proof of any kind of data leakage. The TMS can also oversee the authorization of whoever uploads feedback into the system. It can also identify invalid feedback and discard it from the system. The algorithms of the TMS first establish a variety of trust criteria in which trustworthiness is calculated. Then, feedback from the cloud service provider nodes is accepted only according to the rules of the TMS. A consumer’s trust value is finally computed using a flexible system capable of guaranteeing a good balance of consumer trust and owners' feedback. Furthermore, a majority of the existing TMS models do not take full account of interaction importance, thus impeding the accuracy of the trust values, a shortcoming that has been rectified in our proposed model.

Asthma is a common childhood condition. Its prevalence in Saudi Arabia is high, increasing, and could exceed 20% at the current trajectory. Asthma is a syndrome with different clinical presentations and phenotypes. Many conditions are often misdiagnosed as asthma because they share the same symptoms, particularly coughing and shortness of breath; physical findings, such as wheezing; radiological findings, such as hyperinflation on chest X-ray; or even responses to asthma therapies, as in some patients with bronchiolitis. When treating the younger age group (>5 years old), there should be a high degree of suspicion of alternative causes when evaluating patients presenting with clinical features suggestive of asthma or patients who do not respond well to asthma therapies. This study will highlight common conditions that may mimic asthma and, as a result of incorrect treatment, unnecessarily expose patients to steroids and other therapies for extended periods. Furthermore, we seek to alert healthcare providers to common symptoms and signs that suggest a cause other than asthma and suggest when to refer the patient to subspecialists.

Patient protection has become one of the key elements of the quality of health care systems in Saudi Arabia. Medical errors that threaten patient safety are mediated by several factors including system risk factors. Hence, we used a self-structured questionnaire to assess and rank the system factors according to the perceptions of nurses working in the hospitals of the ministry of health in Hail, KSA. Eight out of twelve factors tested were perceived as threatening factors of the patient safety that are; ‘Shortage of medical staff’, ‘Poor design of the hospital structure’, ‘Long working hours’, ‘Overcrowding of patients’, ‘Poor coordination between hospital departments, ‘Punitive and blaming environment, ‘Lack of clinical practice standards’ and, ‘Poor financial incentives’. Thus, considering the negative impact of the identified threatening system factors in this study on patient safety, urgent planning and managing appropriate corrective actions should be designed to improve patient safety issues.

Background: Edentulism is a common problem that affects patients’ daily activities. The prevalence and pattern of teeth loss could point to the condition of a patient’s oral health. This study aimed to assess the pattern and distribution of partial edentulism, its relation to age and gender, and prosthetic reconstruction for patients visiting the College of Dentistry, Hail University. Methods: It was a cross-sectional observational study. The sample comprised 384 patients. The data were obtained from the patients’ files and panoramic radiographs taken at the dental clinic at College of Dentistry, Hail University. Results: Around 67.7% and 72.9% of females were partially edentulous in maxillary and mandibular jaws, respectively. Furthermore, edentulous males were fewer than edentulous females. Moreover, there was a significant difference between patients’ age and Kennedy’s classification of the maxillary arch. There was a statistically significant difference between Kennedy classes I and III of the mandibular arch and the age groups, where p-value = 0.0001. Furthermore, the usage of removable prostheses was nearly absent in the young patients; its usage increased as the age increased. It was also observed that females underwent missing teeth replacement more than males. Conclusion: Edentulism increases with age, and a higher percentage of edentulism is seen in females as compared to males. Partial edentulism, Kennedy class III, is the most common form of edentulism. Patients are rehabilitated mostly by fixed prosthodontics followed by removable prosthodontics.

Background: Colorectal cancer (CRC) is the most common cancer among men and the third most common cancer among women in Saudi Arabia. Screening for CRC is essential for early diagnosis, prevention, and treatment to reduce healthcare costs and mortality. Objectives: The current study aimed to assess the knowledge and attitude of primary healthcare physicians toward CRC screening in the Qassim region, Saudi Arabia. Participants and Methods: A multicentric prospective, observational study was conducted among 284 primary healthcare physicians in the Qassim region. All participants completed a questionnaire that evaluated their knowledge level related to CRC. The questionnaire also included questions related to demographic data, CRC screening knowledge, and the attitude of the participants. Results: This study included 284 physicians. Their age ranged from 24 to 63 years. The majority were females (55.3%) and non-Saudi (79.2%), only 15.5% knew about the annual screening of fecal occult blood testing, and 33.8% knew about the performance of colonoscopy every 10 years, and 50.7% knew about the performance of flexible sigmoidoscopy every 5 years. The mean score of the knowledge assessment was 4.57 ± 2.23. The overall mean attitude score was found to be 5.69 ± 1.48. Physicians with Board or Ph.D. showed higher levels of positive attitude and knowledge. Conclusion: A low level of knowledge but a fair level of attitude could be noted among the study participants. We found that multiple factors, including nationality, gender, years of experience, and job title, influence the knowledge and attitude levels.

Background: Literature suggests that merely omitting nursing care can put patients in danger and that avoiding these omissions potentially prevents deaths in hospitals. Objective : This study aimed to determine the perspective on the degree of missed nursing care among hospital nurses as it relates to their demographic profile. Method: A quantitative comparative research design was employed in this study. The study was conducted in the public hospitals in Hail City, Kingdom of Saudi Arabia. The study participants were 317 staff nurses, chosen through a simple random sampling, from the public hospitals of Hail City. Data were collected through a self-administered questionnaire between February and June of 2019. Results: The overall mean of the participants’ reported scores was “never missed” at 4.62. Statistically significant results were found in terms of the number of children (0.001), years of experience (0.004), unit of assignment (0.001), and the level of satisfaction with the profession (0.001). All other variables such as gender, age, marital status, and shift were found insignificant, where all of the p -values were more than 0.05. Conclusion: Nurses who had more children, a greater lack of experience, were assigned to a complex unit, and were less satisfied in the profession were more likely to miss nursing care. As such, these errors can compromise the outcomes of nursing care in hospitals.

Angiomyolipoma is the most frequent neoplasm of the kidney. It may have a wide range of clinical manifestations, but it is usually detected incidentally on cross-sectional images. Rupture and hemorrhage of angiomyolipoma is an important concern for large lesions. We present the case of a 42-year-old female, with no history of urinary stones, who presented with a sudden-onset left flank pain for eight hours. Upon examination, she was tachycardic and hypotensive. Abdominal examination revealed a left-sided flank mass. Abdominal computed tomography (CT) scan with intravenous contrast demonstrated a heterogeneous mass lesion in the left kidney with mixed attenuation and had a macroscopic fat density that was surrounded by a large hematoma. Subsequently, transcatheter renal artery embolization was performed with no complications. The procedure was able to control the active bleeding. Then, a total nephrectomy was performed, and the hematoma was evacuated during laparotomy. Spontaneous nontraumatic renal hemorrhage is a very rare condition. Clinicians should keep a high index of suspicion for this condition when they encounter a patient with the clinical triad of flank pain, flank mass, and hypotension. The case demonstrated the role of endovascular embolization of angiomyolipoma to control life-threatening hemorrhage.

AIM This study aimed to explore the perception of other healthcare professionals, including the doctors, physiotherapists and perfusionists, about the nurses' role and competencies in veno-venous extracorporeal membrane oxygenation. BACKGROUND Extracorporeal membrane oxygenation is considered as a challenging clinical activity that requires critical decision and rapid response from nurses, particularly in emergencies. It was observed that nurses are primarily responsible for bedside management of these patients, and teamwork was found helping the nurses to manage this high-acuity care. However, little is known on the perception of other healthcare professionals about the nurses' roles and competencies, which would contribute to further improvements in quality extracorporeal membrane oxygenation care. DESIGN This was a qualitative descriptive study. METHODS One-to-one in-depth interviews were conducted with nine healthcare professionals working in extracorporeal membrane oxygenation care in an adult intensive care unit of a general hospital in Kuwait. RESULTS Participants reported that nurses play critical and multiple roles and responsibilities in the insertion, maintenance, weaning, and retrieval of extracorporeal membrane oxygenation, plus providing general nursing care, and performed their roles competently. Heavy workload, less recognition and support, and individual differences in competence were reported as possible barriers to the nurses' performance. CONCLUSION Other healthcare professionals recognize continuous training, having experience, teamwork, and increased staffing as measures that can promote the nurses' role in extracorporeal membrane oxygenation.

Complex regional pain syndrome (CRPS) is a neuropathic pain disease characterized by the presence of allodynia, hyperalgesia, sudomotor and vasomotor abnormalities, and trophic alterations. CRPS can be caused by a variety of degrees or types of tissue damage, but it has also been reported in the absence of injury or after lengthy periods of immobility. A fracture is the most prevalent injury linked to the development of CRPS. CRPS is thought to be caused by a complex process involving both the peripheral and central nerve systems, according to a recent acceptance. Patients with CRPS are said to have all of the symptoms of inflammation, including heat, discomfort, redness, and swelling. CRPS symptoms have been greatly reduced by corticosteroids in several clinical studies. The diagnosis of CRPS is mostly dependent on a patient's medical history and clinical examination, which includes a variety of tests that can help rule out other diseases. Given the syndrome's complexity, it's doubtful that focusing on a single mechanism will be successful. Combination therapy, like with other chronic conditions, may be the future of CRPS treatment. In this review we will be looking at disease definition, pathophysiology, and treatment.

Background: Breast cancer is the highest burden of disease in high and low income countries and it is the leading cause of disability and death. Knowledge is important predictor of breast cancer. The objective of this study is to determine the knowledge, attitude and practice regarding breast cancer among women visiting public health facilities in Hail, Saudi Arabia. Method: It’s was a cross-sectional study in the leading public sector hospital and 127 study participants were selected through stratified random sampling technique. Validated and structured questionnaire used. Study participants who scored greater than or equal to mean valued were considered good knowledge, positive attitude and safe practice. Chi square test was used to cross tabulation between socio-demographic characteristics and knowledge, attitude and practice score. Results: Over all 18.1%, 47.2% and 52% of study participants had good knowledge, positive attitude and safe practice for prevention of breast cancer respectively. More than two third (89%) of participants were stated that breast cancer was not curable disease, more than half (67.7%) of were heard about mammogram. Only 10.2% were belief that screening was essential to breast cancer for early diagnosis. More than two third (69,9%) were not practice self breast examination and 69% were stated that fear of disease was major barrier to mammogram test. Conclusion: The knowledge level among communities member of female regarding breast cancer was in-appropriate. Majority of them were not practicing self breast examination. Health education programme through workshops and seminars will be needed to increase the awareness toward breast cancer among females.

Introduction The risk of bleeding after dental extractions in patients taking antithrombotic medication is not well known. This study aims to investigate the incidence of postoperative bleeding following dental extractions in adult patients taking antithrombotic medication in Saudi Arabia. Methods This retrospective study included 539 patients aged 18–93 years who attended 840 appointments for dental extractions from January 2012 to June 2016 at a tertiary care hospital in Saudi Arabia. Patients who returned with a complaint of bleeding were treated with local hemostatic measures as outpatients. Results and Conclusion: Only 1.7% of extraction appointments were associated with postoperative bleeding. The highest risk of bleeding was noted in patients receiving warfarin (3.88%), whereas those on clopidogrel had no significant risk of bleeding. Women were found to have the highest rate of bleeding, particularly those on newer oral anticoagulant medications. Dental extractions can be safely done in adults receiving antithrombotic treatment, provided established guidelines are followed; therefore, dental professionals must exercise caution when planning invasive dental treatment for patients on continued antithrombotic therapy.

Potentially inappropriate medication (PIM) is a primary health concern affecting the quality of life of patients over 65. PIM is associated with adverse drug reactions including falls, increased healthcare costs, health services utilization and hospital admissions. Various strategies, clinical guidelines and tools (explicit and implicit) have been developed to tackle this health concern. Despite these efforts, evidence still indicates a high prevalence of PIM in the older adult population. This systematic review explored the practice of using explicit tools to review PIM in hospitalized patients and examined the outcomes of PIM reduction. A literature search was conducted in several databases from their inception to 2019. Original studies that had an interventional element using explicit criteria detecting PIM in hospitalized patients over 65 were included. Descriptive narrative synthesis was used to analyze the included studies. The literature search yielded 6116 articles; 25 quantitative studies were included in this systematic literature review. Twenty were prospective studies and five were retrospective. Approximately, 15,500 patients were included in the review. Various healthcare professionals were involved in reviewing PIM including physicians and hospital pharmacists. Several tools were used to review PIM for hospitalized patients over 65, most frequently Beer’s criteria and the STOPP/START tool. The reduction of PIM ranged from 3.5% up to 87%. The most common PIM were benzodiazepines and antipsychotics. This systematic review showed promising outcomes in terms of improving patient outcomes. However, the reduction of PIM varied in the studies, raising the question of the variance between hospitals in the explicit tools used for review. Additional studies need to be conducted to further investigate the outcomes of reviewing PIM at different levels, as well as assessing the cost-effectiveness of using explicit tools in reducing PIM.

Yousef M Al-saraireh,1 Fatemah OFO Alshammari,2 Ahmed MM youssef,3 Sameeh Al-Sarayreh,4 Ghadeer H Almuhaisen,5 Nedal Alnawaiseh,6 Jehad M Al-Shuneigat,4 Hamzeh M Alrawashdeh7 1Department of Pharmacology, Faculty of Medicine, Mutah University, Al-Karak, Jordan; 2Department of Medical Laboratory Technology, Faculty of Health Sciences, The Public Authority for Applied Education and Training, Shuwaikh, Kuwait; 3Department of Pharmacology, Faculty of Pharmacy, Mutah University, Al-Karak, Jordan; 4Department of Biochemistry and Molecular Biology, Faculty of Medicine, Mutah University, Al-Karak, Jordan; 5Department of Microbiology and Pathology, Faculty of Medicine, Mutah University, Al- Karak, Jordan; 6Department of Public Health, Faculty of Medicine, Mutah University, Al-Karak, Jordan; 7Department of Ophthalmology, Sharif Eye Centers, Irbid, JordanCorrespondence: Yousef M Al-sarairehDepartment of Pharmacology, Faculty of Medicine, Mutah University, PO. Box: 7, Al-Karak, 61710, JordanTel +962799172658Email Yousef.sar@mutah.edu.joPurpose: Colon cancer is a leading cause of mortality worldwide. It has a relatively poor prognosis; therefore, new therapies are needed. One of the tumour-related enzymes that has gained considerable interest is CYP4Z1. This enzyme has been expressed in many tumours and has been hypothesized as a potential biomarker or target for novel anticancer therapies.Patients and Methods: CYP4Z1 overexpression was immunohistochemically examined in a large panel of colon tissue types including normal, benign, primary and metastatic ones, and the enzyme’s relation to histopathological features and patient survival was evaluated.Results: A high CYP4Z1 expression was observed in benign, primary and metastatic colon tissues compared to a weak or lack of expression in normal tissues. Importantly, there was a significant differential in CYP4Z1 expression where it was stronger in metastatic, primary and benign, respectively (p < 0.05). A significantly high rate of CYP4Z1 expression was found in high histological grades and late stages of the disease, where its expression was more evident in patients with metastasis in the lymph nodes (p < 0.05). Interestingly, CYP4Z1 expression was identified an independent prognostic predictor of poor overall survival of colon cancer patients (p = 0.003).Conclusion: CYP4Z1 was distinctly overexpressed in benign, primary and metastatic colon tissues compared to corresponding normal tissues. This differential in CYP4Z1 expression across different types of colon tissues strongly supports CYP4Z1 as potential biomarker and target for novel anticancer therapy development.Keywords: cancer, colon cancer, cytochrome P450, cytochrome 4Z1, immunohistochemistry

Rickets is a worldwide bone disease that is associated with disorders of calcium and phosphate homeostasis and can lead to short stature and joint deformities. Osteomalacia is a major metabolic bone disease that results from a chronic and severe deficiency of vitamin D or phosphate from any cause after growth has stopped. A deficiency of vitamin D or phosphate leads to defective bone mineralization and generalized or localized vague bone pain in various parts of the skeleton and / or proximal muscle weakness. Rickets and osteomalacia are two different clinical diseases with impaired bone mineralization. Rickets occurs throughout the growing skeleton in infants and children, while osteomalacia occurs in adults after fusion of the growth plates. Rickets and osteomalacia are increasingly common in Saudi Arabia, with vitamin D deficiency being the most common etiological cause. Early skeletal deformities can occur in infants, such as soft, thin skull bones, a condition known as craniotabes. In adults, as a result of demineralization, the bones become less rigid (soft bone) with pathological fractures. The diagnosis of both diseases is based on the medical history and physical examination, radiological characteristics, and biochemical tests. Management depends on the underlying etiology.

Aims: To measure knowledge and attitude among the Saudi population about non-steroidal inflammatory drugs. Study Design: This is an observational cross-sectional study. Place and Duration of Study: Conducted in the north region of Saudi Arabia between June 2020 and July 2021. Methodology: The data collection done by using an electronic questionnaire. Total sample size of 1018 participants, aged between 15-60, Female and Male, agree to participate. Each person meeting the inclusion criteria was provided informed consent, explaining the study aim, and ensuring the confidentiality of information. Data were obtained by filling out the designed Questionnaire. Results: A total of 1018 participants completed the survey questionnaire. About 81% of the study participants stated that they have a history of analgesic use without physician prescription in the past six months. More than 30% of participants stated that the pharmacist is the frequent source of recommendation about medication. The most common indication for the participants to use analgesia was headache followed by insomnia. Conclusion: The awareness and attitude of the participants to NSAIDs' usage and its complications was not that adequate. Paracetamol was the most usually used analgesic. It must to teach and strengthen the awareness among citizens about the proper method to use NSAIDs.

We report on the optimized growth of catalyst-free GaN nanowires (NWs)/p-Si by the vapor–solid (V-S) method using chemical vapor deposition (CVD). The effect of NH3 gas flow rate on the morphology and photovoltaic behavior of the material has been investigated. The length and the diameter of the NWs decrease as the NH3 flow rate increases. Raman and X-ray diffraction (XRD) analyses reveal lower internal stress in the prepared NWs. The photoluminescence (PL) spectra indicate strong near band-edge (NBE) peaks extending from 365 to 368 nm and their intensity varied significantly with the NH3 flow rate. The assembled n-GaN NWs/p-Si solar cell devices reveal a maximum conversion efficiency of ∼7.87% under AM 1.5G illumination. This study shows that the morphology, optical, and performance of the fabricated n-GaN NWs on p-Si are strongly affected by the gas flow rate.

Background: We described the demographics, cancer subtypes, comorbidities, and outcomes of patients with a history of cancer and coronavirus disease 2019 (COVID-19). Second, we compared patients hospitalized with COVID-19 to patients diagnosed with COVID-19 and patients hospitalized with influenza. Methods: We conducted a cohort study using eight routinely collected health care databases from Spain and the United States, standardized to the Observational Medical Outcome Partnership common data model. Three cohorts of patients with a history of cancer were included: (i) diagnosed with COVID-19, (ii) hospitalized with COVID-19, and (iii) hospitalized with influenza in 2017 to 2018. Patients were followed from index date to 30 days or death. We reported demographics, cancer subtypes, comorbidities, and 30-day outcomes. Results: We included 366,050 and 119,597 patients diagnosed and hospitalized with COVID-19, respectively. Prostate and breast cancers were the most frequent cancers (range: 5%–18% and 1%–14% in the diagnosed cohort, respectively). Hematologic malignancies were also frequent, with non-Hodgkin's lymphoma being among the five most common cancer subtypes in the diagnosed cohort. Overall, patients were aged above 65 years and had multiple comorbidities. Occurrence of death ranged from 2% to 14% and from 6% to 26% in the diagnosed and hospitalized COVID-19 cohorts, respectively. Patients hospitalized with influenza (n = 67,743) had a similar distribution of cancer subtypes, sex, age, and comorbidities but lower occurrence of adverse events. Conclusions: Patients with a history of cancer and COVID-19 had multiple comorbidities and a high occurrence of COVID-19-related events. Hematologic malignancies were frequent. Impact: This study provides epidemiologic characteristics that can inform clinical care and etiologic studies.

Reem Al Dossary,1 Amani Alnimr,1 Reem Aljindan,1 Khaled R Alkharsah,1 Ahmed K Al-Qurayn,1 Obeid Eltreifi,1 Feras A Alkuwaiti,2 Abdullah B Almashouf,2 Ahmed M Alsahlawi,2 Amal Alshammari,3 Dhoha Hudhaiah,3 Mohammed S Alshahrani,4 Huda Bukhari2 1Department of Microbiology, College of Medicine, Imam Abdulrahman bin Faisal University (IAU), Dammam, Saudi Arabia; 2Department of Internal Medicine, College of Medicine, Imam Abdulrahman bin Faisal University (IAU), Dammam, Saudi Arabia; 3Department of Medical Laboratory, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University (IAU), Dammam, Saudi Arabia; 4Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman bin Faisal University (IAU), Dammam, Saudi ArabiaCorrespondence: Reem Al Dossary P.O Box: 1982, Dammam, 34221 Tel +966 333 0000 ext 35155Email raaldossary@iau.edu.saPurpose: Multiple studies worldwide have reported the clinical and epidemiological features of coronavirus disease 2019 (COVID-19), with limited reports from the Middle East. This study describes the clinical and epidemiological features of COVID-19 cases in the Eastern Province of Saudi Arabia and identified factors associated with the severity of illness.Patients and Methods: This was an observational study of 341 COVID-19 cases. These cases were reported in the first three months after the first case in the country was identified. Clinical and demographic data were analyzed and described to identify the effects of age, sex, and ethnicity on illness severity. In addition, the duration of viral shedding and cycle threshold (Ct) values of real-time PCR were evaluated as predictors of severity.Results: The median age was 45 years. Males were twice as likely to be infected than females (p < 0.0001). The duration of viral shedding ranged from 9 to 36 days. The most common clinical presentations include fever, shortness of breath, cough, myalgia, sore throat, vomiting, and headache. Critical cases were significantly higher in men (23% vs 8.7%), senior adults (> 65 years), individuals of Bengali ethnicity, and in patients with comorbidities including diabetes, hypertension, and dyslipidemia (p =0.001). The case fatality rate was found to be 10%. The fatality was significantly higher in males than females (13.8% vs 2.6%), and in Asians (17.9%) than Arabs (6%) and Africans (0) (p =0.002). No association was found between viral load, represented by the RT-PCR cycle threshold (Ct) values, and severity of illness.Conclusion: Age, sex, and ethnicity are important predictors of COVID-19 severity. The cycle threshold (Ct) of the SARS-CoV-2 RT-PCR test cannot be used as a predictor of the criticality of illness.Keywords: factors, ethnicity, Ct value, Arabs, virus shedding

Scleroderma renal crisis is a life-threatening condition. It usually starts with a sudden onset of severe hypertension, followed by renal failure, hypertensive encephalopathy, congestive heart failure, and/or microangiopathic hemolytic anemia. Renal ischemia, hyperplasia of the juxtaglomerular apparatus, activation of the renin-angiotensin-aldosterone system (RAAS), and an increase in blood pressure are caused by decreased blood flow caused by structural changes in the blood vessels as well as renal vasospasm ("Raynaud's phenomenon"). This overview discusses the evaluation, diagnosis, and treatment of scleroderma renal crisis, emphasizing the importance of early detection of disease, strong correlation of corticosteroids intake and the disease incidence, and best approach of such cases.

Background: Psoriasis is a chronic inflammatory skin illness with an autoimmune pathogenic mannerisms and genetic tendency. It is regarded as erythematous plaques sheltered with silvery scales predominantly over the extensor exteriors, scalp, and lumbosacral region. The prevalence in Saudi Arabia was projected to be 5.3% (53% of psoriasis patients develop it before 30 years of age. Aim: The main objective of this study is to summarize the current evidence regarding prevalence, types, risk factors, associated comorbidities and management of psoriasis in Saudi Arabia. Methods: This is a systematic review was carried out, including PubMed, Google Scholar, and EBSCO that examining previous studies regarding psoriasis in KSA. Authors extracted the data, and then the author's names, year and region of publication, the study type, period of study, and the result were reported. Results: The review included 7 studies that illustrate prevalence, types, risk factors, associated comorbidities and management of psoriasis in Saudi Arabia. Conclusion: The incidence of psoriasis in Saudi Arabia is within previously reported figures worldwide. Family history seems to have a strong association with the occurrence of psoriasis. CVD and psychological disorders seem to be prevalent Saudi psoriatic patients. Topical medications are widely used and effective in psoriasis management in Saudi Arabia.

Coronavirus disease 2019 (Covid-19) is a novel worldwide pandemic caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During Covid-19 pandemic, socioeconomic deprivation, social isolation, and reduced physical activities may induce heart failure (HF), destabilization, and cause more complications. HF appears as a potential hazard due to SARS-CoV-2 infection, chiefly in elderly patients with underlying comorbidities. In reality, the expression of cardiac ACE2 is implicated as a target point for SARS-CoV-2-induced acute cardiac injury. In SARS-CoV-2 infection, like other febrile illnesses, high blood viscosity, exaggerated pro-inflammatory response, multisystem inflammatory syndrome, and endothelial dysfunction-induced coagulation disorders may increase risk of HF development. Hypoxic respiratory failure, as in pulmonary edema, severe acute lung injury (ALI), and acute respiratory distress syndrome (ARDS) may affect heart hemodynamic stability due to the development of pulmonary hypertension. Indeed, Covid-19-induced HF could be through the development of cytokine storm, characterized by high proliferation pro-inflammatory cytokines. In cytokine storm-mediated cardiac dysfunction, there is a positive correlation between levels of pro-inflammatory cytokine and myocarditis-induced acute cardiac injury biomarkers. Therefore, Covid-19-induced HF is more complex and related from a molecular background in releasing pro-inflammatory cytokines to the neuro-metabolic derangements that together affect cardiomyocyte functions and development of HF. Anti-heart failure medications, mainly digoxin and carvedilol, have potent anti-SARS-CoV-2 and anti-inflammatory properties that may mitigate Covid-19 severity and development of HF. In conclusion, SARS-CoV-2 infection may lead to the development of HF due to direct acute cardiac injury or through the development of cytokine storms, which depress cardiomyocyte function and cardiac contractility. Anti-heart failure drugs, mainly digoxin and carvedilol, may attenuate severity of HF by reducing the infectivity of SARS-CoV-2 and prevent the development of cytokine storms in severely affected Covid-19 patients.

Named entity recognition (NER) is a subfield of information extraction, which aims to detect and classify predefined named entities (e.g., people, locations, organizations, etc.) in a body of text. In the literature, many researchers have studied the application of different machine learning models and features to NER. However, few research efforts have been devoted to studying annotation schemes used to label multi-token named entities. In this research, we studied seven annotation schemes (IO, IOB, IOE, IOBES, BI, IE, and BIES) and their impact on the task of NER using five different classifiers. Our experiment was conducted on an in–house dataset that consists of 27 medical Arabic articles with more than 62,000 tokens. The IO annotation scheme outperformed other schemes with an F-measure score of 84.44%. The closest competitor is the BIES scheme, which scored 72.78%. The rest of the schemes’ scores ranged from 60.38% to 69.18%. Although the IO scheme achieved the best results, comparing it to the other schemes is not reasonable because it cannot identify consecutive entities, which the other schemes can do. Therefore, we also investigated the ability of recognizing consecutive entities and provided an analysis of the running-time complexity.

Mahasen Saleh,1 Amani Alkofide,1 Anfal Alshammari,1 Khawar Siddiqui,1 Tarek Owaidah2,3 1Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, 11533, Kingdom of Saudi Arabia; 2Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Kingdom of Saudi Arabia; 3Department of Pathology, Alfaisal University, Riyadh, 11533, Kingdom of Saudi ArabiaCorrespondence: Tarek Owaidah Email towaidah@kfshrc.edu.saBackground: COVID-19 wreaked havoc on the healthcare system, with more than 36 million cases reported globally. Although the pediatric population makes up a lesser proportion of total COVID-19 patients than adults, the clinical status, age and comorbidities warrant identifying possible prognostic factors associated with disease severity in this group. The current study aimed to explore the incidence of thrombosis, overall outcome, and different hematological and coagulation markers in children with COVID-19.Methods: This is a single-center prospective study of 43 patients (age < 14 years) with confirmed COVID-19 diagnosis recruited from April to August 2020. Data for clinical presentation were collected and analyzed. The samples were tested for different hematological and coagulation markers.Results: Twenty-nine (67.4%) were symptomatic at presentation, with fever being the most common symptom (n = 23, 53.5%), followed by respiratory (n = 5, 11.6%) and gastrointestinal symptoms (n = 3, 7%). Co-morbid conditions were recorded in 26 (60.5%) patients, with malignancy being the commonest (n = 9, 20.9%). In this cohort of patients with age < 14 years, hypertension, respiratory symptoms and ABO group-A were significantly associated with pediatric intensive care unit (PICU) admission during the course of treatment. Patients with elevated FVIII and fibrinogen levels at presentation were more likely to have an extended length of hospital stay (LOS) (P–value =0.036 and 0.032 respectively). No thrombotic event was observed in our cohort. D-dimer values were higher (above 0.5 μg/mL) in 24 (55.8%) patients at admission. We found an association between high D-dimer and PICU admission and LOS.Conclusion: Although we did not observe thrombosis in our cohort, serial measurements of D-dimer and elevated FVIII bear a prognostic value in predicting the need for critical care in children with COVID-19. Further studies with larger sample size can aid in the establishment of prognostic factors for the pediatric COVID-19 population.Keywords: COVID-19, children, hematological and coagulation markers

Introduction and Objective Interferential current IFC is one of the common electrotherapeutic modalities used in the treatment of painful conditions. Patients with musculoskeletal pain seek medical help in order to reduce their pain that could be achieved using IFC.The current review aims to analyze the recently available information regarding the efficacy of the IFC in alleviating the pain of musculoskeletal origin. State of knowledge IFC, as one of the medium frequency currents, has the advantage of being more comfortable and deeply penetrating so that it can reach deeper painful tissues. It has been proposed that IFC can relieve pain through stimulating different body mechanisms, such as the gate mechanism and the release of body opioids. However, the evidence behind the effectiveness of IFC as a pain-relieving modality for musculoskeletal pain has been poorly studied and still not conclusive Conclusions This systematic review will summarize the effects of IFC on relieving musculoskeletal pain as reported through improvement in visual analog scale, numeric pain rating scale, or the McGill pain questionnaire. Through searching multiple databases and including randomized controlled trials published during the last ten years, the findings of the current systematic review and meta-analysis will establish the quality of the recently available evidence and demonstrate if there will be a need for further studies.

The onset of COVID-19 has harmed community pharmacy. As a result, the current study sought to investigate how the coronavirus disease affected community pharmacies from an economic perspective. Short interviews were conducted with 158 community pharmacies located in Riyadh, Saudi Arabia. The findings showed that most of the community pharmacies incurred losses of over 10% as a result of the COVID-19 pandemic during its first month in Saudi Arabia. Specifically, the findings revealed that 19.6% of the pharmacies had a 0.1-2% profit during the first month,1.9% had 10%+ profit, while 13.9% experienced a drop in profits. According to the findings, 41.8% (n = 66) of the pharmacists were not sure what they dispensed during the first month of COVID 19. However, almost one out of every five pharmacies (n = 31, 19.6%) accepted that they mostly dispensed antipyretic, vitamins, face mask and sanitisers. It could take many years from now until researchers can understand and measure the coronavirus disease as required. Based on these outcomes and possibilities, the study recommends that the Saudi Arabia Ministry of Health intervene to enlighten the public on appropriate health practices. Besides, the Ministry of Health may consider engaging with policymakers in developing financial policies that protect community pharmacies and the private sector from potential losses. Moreover, the Ministry of Health may expand the role of community pharmacies to allow them to offer home care services.

Acute leukemia is often regarded as a popular malignancy affecting children. Noticeable enhancements in the treatment of childhood acute lymphoblastic leukemia, as well as acute myeloid leukemia have resulted in an upsurge in the cure rates. Presently, 80% of the children affected by acute lymphoblastic leukemia and 50% of those affected by acute myeloid leukemia can benefit from long-term remission. However, salvage routines have been very poor in some cases. Some of these cases include those that entail primary refractory disease, multiple relapses, as well as early systematic relapse. Relapsed leukemia is the fourth most popular malignancy affecting children, and there is need to develop novel therapeutic alternatives that can cater for this primary group of patients. With this perspective in mind, clofarabine remains to be the original and only anticancer drug that was certified for use in children and has been in use for over 10 years even before it was actually used in adults. There is need to include clofarabine in reduced-intensity conditioning (RIC) allogenic hematopoietic stem cell transplantation (HSCT) in the treatment of severe leukemia. Such an inclusion could possibly enhance the treatment outcomes. It is also necessary to design research that can examine the outcome of clofarabine based regimen as bridge therapy to stem cell transplant in young patients with refractory or relapsed leukemias.

Research studies have indicated that the comorbidity burden of mood disorders and obesity is reasonably high. Insulin signaling has been shown to modulate multiple physiological functions in the brain, indicating its association with neuropsychiatric diseases, including mood disorders. Leptin is a hormone responsible for regulating body weight and insulin homeostasis. Previous studies on db/db mice (a mouse model that carries a spontaneous genetic mutation in leptin receptor Leprdb ) have shown that they exhibit inflammation as well as neurobehavioral traits associated with mood. Therefore, targeting inflammatory pathways such as TNF-α may be an effective strategy in the treatment of obesity-linked mood disorders. The objective of this study was to investigate the effect of long-term administration of etanercept (a TNF-α blocker) on anxiety and depressive-like behaviors in db/db mice. This was performed using light/dark box, forced swim, and open field tests with lean littermate wild type (WT) mice serving as a control group. Using flow cytometry in peripheral blood, we further examined the molecular effects of etanercept on NF-κB p65, TNF-α, IL-17A, and TLR-4 expressing CD4+, CD8+, and CD14+ cells in the peripheral blood. Our data show that peripheral administration of etanercept decreased these cells in db/db mice. Furthermore, our results indicated that peripheral administration of etanercept reduced anxiety and depressive-like behaviors. Therefore, targeting TNF-α signaling might be an effective strategy for modulating obesity-associated depression and anxiety.