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Background: Gallstone disease is one of the most resource-intensive surgical conditions. Despite the significant burden of emergency cholecystectomy on healthcare system, there is lack of research assessing the risk factors predisposing scheduled elective cholecystectomy patients to emergency surgery. Characterization of patients with gallstones helps to prioritize delivery of health care to avoid urgent surgery. The objective of the present study is to analyze risk factors associated with emergency cholecystectomy and assess the impact of delay on electively scheduled patients., Methods: This retrospective cohort study at a tertiary care center in Jeddah, Saudi Arabia, between January 2018 and June 2022. Net total of 823 patients.The study has collected data retrospectively from an electronic health record system. The data were entered and coded in excel sheet. All statistical tests were 2-sided and were conducted using SAS statistical software version 9.4 (SAS Institute Inc. Cary, NC)., Results: A total of 823 patients met the inclusion criteria and enrolled in the analysis. Among them, 129 patients (15.67%) underwent emergency cholecystectomy, while 694 patients (84.33%) underwent elective cholecystectomy. The waiting time in days was significantly longer for patients undergoing emergency cholecystectomy (mean of 362 days) compared to those undergoing elective cholecystectomy (mean of 305 days). Patients with more than two previous ED visits were over five times more likely to undergo emergency cholecystectomy compared to those who had never visited the ED previously (p-value < 0.0001) Moreover, patients diagnosed with acute cholecystitis and pancreatitis were more likely to undergo emergency cholecystectomy compared to those not diagnosed with these conditions (p-value < 0.0001; p-value 0.02)., Conclusion: Analysis of risk factors and delay in patients with gallstones scheduled for elective cholecystectomy demonstrates that long waiting times, severity of the initial visit setting, Hemolytic anemia, and male gender were significantly related to emergency cholecystectomy. Independent risk factors for emergency cholecystectomy were frequency of ED visits, acute cholecystitis, pancreatitis, and CBD stone. Patients with these risk factors should be given priority on the waiting list to avoid emergency surgery. Future research is required to design a scoring system or specific criteria for elective patients at risk of developing acute cholecystitis., Competing Interests: Declarations. Ethics approval and consent to participate: The need for consent to participate was waived by our Institutional Review Board (IRB) and was deemed unnecessary according to national regulations. Approval by: King Abdullah International Medical Research Center (KAIMRC) Saudi Arabia E-CTS Ref. No : JED-23-427780-11385. National Committee Of Bioethics Registration No : H-01-R-005. IRB Approval No: IRB/0235/23. Study Number: NRJ22J/312/11. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Polycystic ovarian syndrome (PCOS) is the most prevalent endocrine concern among women of reproductive age. In Saudi Arabia, there is a lack of evidence to identify who is at higher risk of PCOS and what the potential risk factors are. Thus, this study aimed to investigate the associations of PCOS risk with demographic and socioeconomic characteristics, access to healthcare, health behaviors, and health status., Methods: This cross-sectional study was conducted among women in all different regions of Saudi Arabia to assess PCOS risk and related factors. Ethical approval was obtained, and data collectors distributed anonymous, self-administered questionnaires through social media platforms, with informed consent from participants. Sociodemographic characteristics, health behaviors, and perceived stress were measured, with stress assessed using the Arabic version of Cohen's Perceived Stress Scale. Data management and analyses included statistical description, bivariate analysis, and multinomial logistic regression analyses using SPSS, with significance set at p < 0.05., Results: The majority were younger than 30 years old, single, educated, urban residents, employed or students, and non-smokers. Most participants reported no chronic illnesses, with an average stress level of 19.71 (± 6.68). Concerning the risk of PCOS, 41.3% were at low risk, 33.3% were at suspected risk, 2.9% were at high risk, and 22.5% were diagnosed with PCOS. Factors associated with PCOS risk included age, region of residence, income, weight status, smoking status, presence of chronic conditions, medication and herbal remedy use, and perceived stress. Adjusted findings indicated that younger age, lower income, and higher stress levels were linked to an increased risk of PCOS, while chronic conditions were significantly associated with PCOS diagnosis rates., Conclusion: The study suggested the need for tailored interventions addressing lifestyle, stress, and comorbid disease management to reduce the risk of PCOS and improve women's health outcomes., Competing Interests: Declarations. Ethics approval and consent to participate: Per the Declaration of the Declaration of Helsinki, all procedures and documents were reviewed and approved by the Institutional Review Board (IRB) at Princess Nourah Bint Abdulrahman University (IRB log No. 23–0975). Participants provided informed consent before taking part in the survey. The online survey required participants to confirm their consent by checking a box on the first page before continuing. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. Risk factors of mortality in patients with AMI have been widely investigated, identifying older age and heart failure as common contributors. This study aimed to determine risk factors and explore predictors associated with higher mortality among patients with AMI. A retrospective study was conducted at a cardiac center in western Saudi Arabia (KSA) between January 1, 2023, and September 1, 2023. Inclusion criteria comprised patients with a confirmed diagnosis of AMI. Exclusion criteria included patients younger than 18 and those with incomplete diagnostic or follow-up data. A data collection form was generated, including all possible factors associated with mortality among patients with AMI. The study included 851 MI patients with a mean age of 58.78 years, primarily male participants. Survival analysis based on the days of hospitalization revealed that 30-day and 60-day survival rates post-hospitalization were 66.8% and 33.4%, respectively. Patients with acute MI of the anterior wall or other specific sites demonstrated significantly higher risks of mortality compared to those with unspecified acute MI. Elevated creatine kinase-myocardial band (CK-MB) levels and blood urea nitrogen (BUN) were also significantly associated with increased mortality risk. The findings highlighted an association between mortality and diabetes mellitus (DM) and transmural MI of the anterior wall. Significant differences between surviving and deceased patients were observed in several factors, including troponin, CK-MB, low-density lipoprotein (LDL), BUN, creatinine levels, age, and hospital stay duration., Competing Interests: The authors declare no conflict of interest., (© 2024 by the authors.)

Background: Strokes represent a major global health challenge, as they now affect up to 15 million people annually, with increasing mortality rates accompanying growing prevalence. In Saudi Arabia, hypertension (HTN) and diabetes mellitus (DM) have been identified as major contributors to stroke risk, with a combination of HTN and DM significantly magnifying the risk of strokes. While there have been global improvements in stroke prevention, recently knowledge levels vary significantly worldwide, and multiple studies in Saudi Arabia show inconsistent awareness levels., Objectives: This study seeks to develop insights for the development of tailored prevention programs that align with Saudi Vision 2030 in terms of enhancing quality of life. Thus, the aim of the study is to assess knowledge levels of stroke risk factors, warning signs, symptoms, and prevention methods among high-risk groups (HTN and DM patients) at King Saud University Medical City (KSUMC)., Methods: This was an analytical cross-sectional study conducted among 422 participants from June 2022 to January 2023, using a validated Arabic questionnaire taken, with permission, from previous studies. All HTN and T2DM patients in the waiting areas of the outpatient clinics at KSUMC, Riyadh were included as part of the random sampling, though patients below 20-years-old and those with other endocrine disorders were then excluded., Results: The majority of participants were male (64.5 %). The analysis showed that 66.1 % of participants had "poor total knowledge" of stroke factors. Half of the participants (50.5 %) had "poor knowledge" about stroke risk factors, though the most commonly identified risk factor was "hypertension". Additionally, the findings showed that 46.4 % of participants had "poor knowledge" of stroke warning signs and symptoms, with the most commonly identified warning sign being "difficulty in speaking." Nearly half of participants (46.4 %) had "good knowledge" of stroke prevention methods; however, "regular exercise" was the most commonly identified prevention method., Conclusion: Although the participants displayed decent knowledge of stroke prevention methods, several notable deficits in overall knowledge of stroke factors emerged. In particular, knowledge of stroke risk factors and warning signs and symptoms among participants was inadequate. This implies that healthcare providers should seek to launch campaigns addressing stroke knowledge mainly among high-risk groups, potentially distributing brochures about stroke knowledge in the relevant clinics and seeking to provide a range of educational content by means of social media., Competing Interests: Declaration of competing interest The authors declare that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: A pulp stone is a calcified mass that develops in the dental pulp of any tooth. Despite many studies examining the relationship between pulp stone formation and non-oral factors, the methods used in these studies have been unable to explain the exact role of these factors alone as distinct from probable effects within the oral cavity environment. Considering that totally unerupted (impacted or developing) teeth are unexposed to the oral cavity's environmental and functional conditions, they provide a more suitable material for studying the effects of these non-oral factors on pulp stone formation. This research study aimed to investigate pulp stones in unerupted teeth and the associated factors in a Saudi subpopulation., Methods: The study included 644 cone-beam computed tomography images, with 496 (50.9%) maxillary and 479 (49.1%) mandibular teeth. Of the investigated patients, 293 (45.5%) were men, and 351 (54.5%) were women. The age range was 15-76 years. A chi-square test was used to investigate the associations between pulp stones and age, gender, and history of systemic disease and chronic medication use., Results: Pulp stones in unerupted teeth were present in 24.2% of the examined dental jaws and 18.6% of the examined teeth. There was no statistically significant relationship between pulp stones and gender (p > 0.05). A significantly greater percentage of pulp stones were found with increasing age (p = 0.000). Additionally, a significantly increased number of pulp stones was observed in patients with systemic diseases and chronic medications (p < 0.05)., Conclusions: The results support the idea that pulp stones can be present in any type of unerupted tooth. This study provides additional evidence of the increased incidence of pulp stones with age, systemic disease, and chronic medications., (© 2024. The Author(s).)

Background: Self-efficacy is a popular psychological concept that refers to an individual's perception or belief in his ability to perform specific actions. This study aimed to assess the predictive value of self-efficacy, measured using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S) questionnaire, for diabetes management and overall well-being in patients with diabetes., Subject and Methods: An anonymous online cross-sectional study was conducted to evaluate the self-efficacy of diabetic patients in the Asser region of Saudi Arabia. The participants were requested to upload their most recent glycated hemoglobin A1C (HbA1C) measurements taken in the last three months, which helped in the accurate categorization of their diabetes as either controlled or uncontrolled. We used the valid Arabic version of the SEM6S and WHO-5 well-being questionnaires to assess patient self-efficacy and well-being., Results: A cohort of 342 patients was enrolled in the study, 67.25% were married, their mean age was 43.17 ± 17.61 years, and 52.69% had university-level or higher education. Among the participants, 46.0% exhibited well-being, while 24.9% reported poor well-being, including 9.4% who were identified as experiencing depression. The mean scores of self-efficacy and well-being were significantly higher among those with controlled diabetes versus uncontrolled diabetes (40.86 ± 13.26 vs. 36.48 ± 13.26) and (67.35 ± 21.22 vs. 60.93 ± 25.05), respectively. The predictors of glycemic control were self-efficacy [Odds ratio (OR)=1.03 (95%CI, 1.01-1.06, P =0.002], having other chronic diseases [OR=3.25 (95%CI), P <0.001], having type 1 diabetes [OR=7.16, 95%CI, P =0.005], being Saudi [OR=7.67, (95%CI, P =0.027], working in a public sector [OR=0.15, (95%CI, 0.05-0.44), P =0.005], being unemployed [OR=0.19, (95%CI, 0.06-0.59), P =0.005], being a smoker [OR=0.44, 95%CI, 0.19-0.98, P =0.048], and duration of diabetes between 6-10 years [OR= 0.33, 95%CI, 0.11-0.95), P =0.043] or more than 10 years OR=0.32, 95%CI, 0.12-0.86), P =0.026]. The main determinants of well-being were having self-efficacy [OR=1.07 (95%CI, 1.04-1.09), P = 0.0001], having public health insurance [OR=4.36 (95%CI, P =0.015], and education level (read and write) [OR=0.13 (95%CI,.02-.70), P =0.021]., Conclusions: The study reveals that non-modifiable and modifiable factors, including self-efficacy, play a crucial role in diabetes control. The study recommends providing targeted educational interventions, using different social media platforms, psychosocial support programs, and inclusive healthcare policies to improve diabetes control and mental well-being among diabetic patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Alshaikh, Al-Qahtani, Alqahtani, AlFarhan, Al Nuwayhidh, Madkhali, AlQahtani, AlAsmari, Alserhani, Alqubaisi, Saeed Aldawh, Al Bin Ahmad and Ghazy.)

Objectives: This is the first national study to investigate the incidence of non-syndromic oro-facial clefts (NSOFC) and Pierre-Robin-Sequence in Saudi Arabia over the Covid-19 pandemic period., Methods: All maternity hospitals (30-hospitals) in the major regions and cities of Saudi from November 2020-to-2021 were included in the study. Patients were evaluated for cleft phenotype using the LASHAL-classification system. The incidence of NSOFC in Saudi Arabia was calculated by comparing the number of NSOFCs cases born out of all live births during the study period at the included hospitals. Clinical examination was performed and information was gathered using a validated data collection form., Results: In one year, 140,380 live-infants were born at the selected hospitals. Of these, 177 were diagnosed with NSOFC giving an incidence of 1.26/1,000 live-births in Saudi Arabia and the highest incidence in Medina city (2.46/1000 live-births). The incidence of cleft lip-and-palate (0.67/1000 live-births) was higher than that of cleft-palate (0.37/1000 live-births) and cleft-lip (0.22/1000 live-births). Pierre-Robin Sequence incidence was (0.04/1000 live-births). There were 21(12.1) or 23(13.2%) of NSOFC's mothers exposed or vaccinated with Covid-19, respectively., Conclusion: The national incidence of NSOFC in Saudi Arabia was 1.26/1000 live births with variation between phenotypes and regions in the country. In addition, to reporting Covid-19 infection prevalence and vaccine exposure among NSOFC's mothers, this study represents the first of its type to evaluate NSOFC prevalence in Saudi Arabia on a national level., (© 2023. The Author(s).)

Background: Female sex is considered an independent predictor for mortality and morbidity following cardiac surgery. This study is to review the outcomes of adult cardiac surgery between males and females in a Saudi tertiary referral hospital., Method: This was a retrospective study for 925 adult patients operated on for ischemic coronary artery disease and acquired aortic and mitral valvular heart disease from 2015 to August 2023. We analyzed patient characteristics, intraoperative data, and postoperative results to compare outcomes between males and females., Results: Preoperative risk factors were not significantly different in both groups. Postoperative outcomes showed gender-based differences. In univariable analysis, females, compared to males, had significantly greater odds of prolonged postoperative ventilation (>24 hours), 32.8% of females compared to 20.7% of males (p < 0.001). Also, sternal wound infection was notably higher among females (13.3%) (p < 0.001). Mortality also exhibited a significant association, with 14.2% of females experiencing mortality compared to 9.4% of males (p = 0.049). In the multivariable analysis for elevated postoperative troponin, the use of pre-operative intra-aortic balloon pump, urgent/emergent surgery, elevated pre-operative troponin and combined bypass grafting with valve surgery, were also predictive of higher post-operative troponin concentrations (beta = 0.43, 95% CI: 0.25 to 0.62, p < 0.001)., Conclusion: Females in Saudi Arabia have an increased risk of short-term morbidity and mortality after cardiac surgery compared to males. Vague and delayed presentation and then the late diagnosis and referral are likely the main contributing factors. This highlights the need to implement preoperative measures to improve early diagnosis and referral to eliminate gender bias.

Background and Objectives : Skin problems are a widespread issue that affects people in both developing and wealthy countries, posing significant public health concerns. These disorders can profoundly impact individuals' social and psychological well-being. In this study, we aimed to determine the prevalence of the most common skin diseases in the Jazan region of southwestern Saudi Arabia and investigate their impact on patients' quality of life and psychological and social well-being. Materials and Methods : An observational cross-sectional survey conducted among a random sample of 940 adults ≥ 18 years in the Jazan region, Saudi Arabia. Four standardized questionnaires were used for data collection: Patient Health Questionnaire (PHQ-9), a five-dimension questionnaire (EQ-5D), Rosenberg Self-Esteem Scale, and Loneliness Scale (ULS-8). Results : The most prevalent skin conditions involved hair loss, which was reported by (61.1%) of the study population. These disorders significantly affected a higher percentage of females (71.9%) compared to males (46.3%) ( p < 0.001). Melasma was more common in females (14.1%) than in males (4.3%) p < 0.001. The lowest prevalence was found for urticaria. Those with acne and hair loss reported higher mean scores on the PHQ-9 Scale than the group without these conditions ( p < 0.05 for all). Patients with alopecia, acne, and melasma also reported significantly lower self-esteem scores compared to those without these skin conditions ( p < 0.05 for all). Regarding the activity domain of QoL, participants with skin conditions reported no problems doing usual activities, compared to those without skin problems ( p < 0.001). Conclusions : In conclusion, research revealed that the most prevalent skin condition was hair loss. Further, an association was found between skin diseases and the mental and social well-being of those affected, resulting in a negative impact on their quality of life. The results call for improving the condition of patients with skin diseases, improving their quality of life, and providing appropriate interventions.

Polypharmacy, often defined as the concurrent use of five or more medications, has become increasingly common due to various factors, including shifts in lifestyle and a rise in health-related issues among individuals. However, using multiple medications could bring more issues to the patient, as it is linked to poor health outcomes, including medication nonadherence, adverse pharmacological effects, and decreased quality of life (QoL). This study aimed to determine the prevalence of polypharmacy and identify drug-related problems among adult patients in Al-Ahsa. A cross-sectional study was conducted among adult patients living in Al-Ahsa, Saudi Arabia, taking five or more medications. A self-administered questionnaire was distributed among the target population using an online survey. The questionnaire included sociodemographic data (i.e., age, sex, education, etc.), a questionnaire to assess behaviors regarding the use of polypharmacy, and a 10-item questionnaire to measure medication-related quality of life (MRQoL). In total, 196 of the 1,088 patients surveyed took five or more medications, indicating an 18% prevalence of polypharmacy. Among the 196 patients, 26.5% reported poor medication-related QoL. In univariate analysis, sex, occupational status, average monthly income, hypertension, asthma, difficulty managing medications, and side effects experienced were significantly associated with MRQoL. Independent significant predictors of poor MRQoL were having asthma and difficulty managing medications. The prevalence of poor medication-related quality of life among adult patients in our region was 26.5%, lower than that in previous studies. Poor MRQoL was associated with lower monthly income, hypertension, asthma, side effects, and difficulty managing medications., Competing Interests: The authors declare no conflict of interest., (©2023 JOURNAL of MEDICINE and LIFE.)

This study aims to introduce national diagnostic reference levels (NDRLs) for adult hybrid single photon emission computed tomography (SPECT-CT) in nuclear medicine (NM) departments in the Kingdom of Saudi Arabia. The administered activity (AA) of radiopharmaceuticals, volume-weighted computed tomography dose index (CTDI vol ) and dose length product (DLP) for ten hybrid SPECT/CT examinations were collected and analysed for one year. The median of AA, CTDI vol and DLP for each dose quantity was derived and the suggested national DRLs were determined based on the 75 th percentile for all identified SPECT-CT examinations. A comparison of the defined adult NDRLs in Saudi Arabia with the published data of other countries was performed. Although there are no significant variations of the proposed NDRL of AA between countries, the proposed NDRLs of the integrated CT metrics exceed the published data in most procedures. NM departments are urged to consider optimisation for both image quality and radiation protection., (© 2023 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights reserved.)

Introduction: Bariatric surgery is the most effective procedure for sustained weight loss and control of obesity-associated comorbidities among morbidly obese patients. Successful bariatric surgery depends on a multidisciplinary approach involving all healthcare workers, including the primary care physicians, from the referral of patients to long-term follow-up. The present study assessed the knowledge, attitude, and potential referral barriers of primary care physicians to bariatric surgery and associated sociodemographic factors. Materials and methods: The present analytical cross-sectional study was conducted among 280 randomly selected primary care physicians using a standard and validated data collection tool. We performed an independent t-test and one-way ANOVA to find the association between sociodemographic characteristics and knowledge, attitude, and referral barrier scores. Furthermore, multilinear regression analysis was executed to determine the association among knowledge, attitude, and barriers. Results: The current study found that 52.9%, 19.3%, and 59.3% had a low score in the knowledge, attitude, and barriers categories. The attitude scores were significantly associated with the education status ( p = 0.005) and current position at primary health centers ( p = 0.012), and the referral barriers score was significantly associated with the work experience duration ( p = 0.004). We found a positive relationship between knowledge and attitude (regression coefficient (β) [95% CI]:0.389 [0.154 to 0.585], p = 0.001) and a negative relationship between knowledge and referral barriers (β [95% CI]: -0.291 [-0.127 to -0.058], p = 0.007). Conclusions: Our survey findings suggest that a lack of knowledge regarding bariatric surgery led to several concerns and referral barriers among the physicians. Therefore, the recommendation is to improve the primary care physicians' knowledge through continuing medical education, symposium, and other suitable training methods with a special focus on obesity care in the curriculum. Furthermore, a mixed-method survey involving other provinces of the KSA is warranted to formulate the region-specific training needs.

Breast cancer is the most commonly diagnosed cancer among women in the Kingdom of Saudi Arabia and other Middle East countries. This analytical cross-sectional study assessed knowledge, attitude towards breast cancer, and barriers to mammogram screening among 414 randomly selected female healthcare workers from multiple healthcare facilities in northern Saudi Arabia. Of the studied population, 48.6% had low knowledge, and 16.1% had a low attitude towards breast cancer risk factors and symptoms. The common barriers to mammogram screening were fear to discover cancer (57.2%) and apprehension regarding radiation exposure (57%). Logistic regression analysis found that lack of awareness regarding mammogram was significantly associated with age (p = 0.030) and healthcare workers category (ref: physicians: p = 0.016). In addition, we found a significant negative correlation between knowledge and barrier scores (Spearman’s rho: −0.315, p < 0.001). It is recommended to develop target-oriented educational programs for the healthcare workers, which would empower them to educate the community regarding the risk factors and the importance of mammogram screening. Furthermore, a prospective study is warranted in other regions of the Kingdom of Saudi Arabia to understand the region-specific training needs for the healthcare workers.

Aim: This study explored the Coronavirus Disease 2019 (COVID-19) pandemic effects on overseas Pakistani's residing in various parts of the world, particularly in China, Saudi Arabia (SA), and the United Kingdom (UK)., Methods: This cross-sectional study was completed between November 2020 and April 2021. An online questionnaire was designed and circulated via various social media mediums to overseas Pakistani communities. The obtained data were statistically analyzed through SPSS version 19 for windows. P < 0.05 was considered statistically significant., Results: A total of 542 overseas Pakistani participated in the current study. In total, 157 (29%) were females and 385 (71%) males. There were 174 (32.1%), 142 (26.45%), 117 (21.6%), and 109 (19.85%) participants from the UK, SA, China, and other countries respectively. Some participants, or their family members, 93 (17.2%), got infected with the COVID-19. About one-third, 165 (30.4%), of the respondents were afraid that their company would violate their contracts or lose their jobs or be paid less. The majority, 469 (86.5%), believed that the lockdown is increasing their psychological stress. More than half of the participants, 314 (57.9%), stated that the Pakistani embassy did not facilitate them in their country of stay. About one-third, 194 (35.8%), of the respondents faced visa-related issues. More than one-third of respondents, 221 (40.8%), faced health issues due to lack of physical activities during the lockdown. Males were afraid that their company would violate their contract, lose jobs, or be paid less than females ( p < 0.001). Both genders had psychological stress and health issues because of the pandemic. The participants from SA faced more visa-related issues, and they were less satisfied with the efforts of the Pakistani embassy to facilitate them compared to the UK and China participants ( p = 0.013)., Conclusion: Our data indicate that the COVID-19 pandemic impacted Pakistanis living in the UK, SA, China, and other parts of the world. They had health-related issues, visa problems and dissatisfaction with Pakistani embassy facilitations. Pakistanis living abroad require government assistance to resolve their issues., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ahmad, Murtaza, Ahmad, Murad, Baig, Imtiaz, Baig, Baig, Siraj and Sagga.)

Objectives: To determine the seropositivity of Immunoglobulin-G and Immunoglobulin-M to hepatitis E virus in male blood donors in Makkah, Saudi Arabia., Methods: The study was carried out from March to August 2009, in which 900 blood samples were collected from 4 different hospital blood banks in Makkah City: AL-Noor Hospital, Central Blood Bank, Maternity and Children Hospital, and Herra Hospital. All the samples were tested for Immunoglobulin-G and Immunoglobulin-M antibodies specific to hepatitis E virus using the enzyme-linked immunosorbent assay test., Results: Hepatitis E virus-specific Immunoglobulin-G antibodies were detected in 168/900 (18.7%), and IgM in 39/900 (4.3%) samples. Prevalence of the former was found to be higher in non-Saudi donors. In addition, its prevalence increased with age. Moreover, its prevalence was found to be higher in uneducated donors and in donors who drank well-water., Conclusion: Exposure to hepatitis E virus among blood donors in Makkah City was high in comparison to the neighbouring areas in the region. Further studies are warranted to determine the true seroprevalence of the virus in the society at large.

Recent studies have suggested a potential prognostic role of alterations of the fragile histidine triad (FHIT) gene in diffuse large B-cell lymphoma. To evaluate possible mechanisms of FHIT inactivation and to further clarify its potential prognostic relevance, we analyzed a set of 114 diffuse large B-cell lymphoma with clinical follow-up information. Tissue microarrays were analyzed by immunohistochemistry for protein expression, and corresponding DNA samples were analyzed for FHIT promotor hypermethlyation. Reduced or absent FHIT expression was found in 75 of 114 diffuse large B-cell lymphoma (66%), but was unrelated to clinical tumor stage or patient prognosis. FHIT promotor hypermethylation was observed in 29 of 93 (23%) interpretable diffuse large B-cell lymphoma. Hypermethylation was not significantly correlated to protein expression loss, which could be explained by competing mechanisms for FHIT inactivation in a substantial fraction of non FHIT hypermethylated diffuse large B-cell lymphoma. Hypermethylation was significantly associated with poor prognosis of diffuse large B-cell lymphoma patients and predominantly seen in nongerminal center diffuse large B-cell lymphoma (27%), but less frequent (13%) in germinal center diffuse large B-cell lymphoma. In summary, these data suggest that promotor hypermethylation is responsible for reduced FHIT expression in a substantial subset of diffuse large B-cell lymphoma, which is primarily composed of nongerminal center subtype with poor patient prognosis.

Several clinically relevant molecular classifiers of diffuse large B-cell lymphoma (DLBCL) have recently been demonstrated in Western populations. However, substantial molecular differences have recently been shown between tumors derived from different ethnic groups. To investigate prevalence and interrelationship of recently suggested molecular prognostic markers in Middle East DLBCL, we analyzed coexpression of CD10/Bcl6 (by immunohistochemistry), t(14;18) translocations (by fluorescence in situ hybridization), and methylation of the gene encoding the DNA repair enzyme O(6)-methylguanine DNA methyltransferase (MGMT) in a series of 190 DLBCL patients from Saudi Arabia with clinical follow-up data. Coexpression of CD10/Bcl6 (germinal center-like immunophenotype) was found in 13%, t(14;18) translocations in 17.9%, and MGMT methylation in 75.9% of cases. There was a trend toward better prognosis (although statistically insignificant) in tumors with coexpression of CD10/Bcl6. MGMT methylation were significantly related to good prognosis. The combined analysis of both parameters revealed that MGMT methylation was independent of immunophenotype and remained a significant predictor of prognosis in nongerminal center-like DLBCL subgroup. t(14;18) was significantly associated with CD10/Bcl6 coexpression (46.7%) but infrequent in CD10-/Bcl6-negative lymphomas (9.4%; P = .0073). However, t(14;18) was unrelated to clinical outcome. In summary, our data suggest a strong prognostic importance of MGMT methylation independent of DLBCL immunophenotype. Based on previous data from Western patients, the rate of MGMT hypermethylation was higher, and the portion of germinal center-like DLBCL was lower than expected. These results provide evidence for molecular differences between Saudi Arabian and Western DLBCL.