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Background. The nonvitamin K antagonist oral anticoagulants (NOACs) have become the mainstay anticoagulation therapy for patients requiring oral anticoagulants (OACs) in the Gulf Council Cooperation (GCC) countries. The frequency of NOAC-associated major bleeding is expected to increase in the Emergency Department (ED). Nonetheless, we still lack local guidelines and recommendations for bleeding management in the region. The present Delphibased consensus aims to establish a standardized and evidence-based clinical care pathway for managing NOAC-associated major bleeding in the Kingdom of Saudi Arabia (KSA) and the United Arab Emirates (UAE). Methods: We adopted a three-step modified Delphi method to develop evidence-based recommendations through two voting rounds and an advisory meeting between the two rounds. A panel of 11 experts from the KSA and UAE participated in the consensus development. Results: Twenty-eight statements reached the consensus level. These statements addressed key aspects of managing major bleeding events associated with NOACs, including the increased use of NOAC in clinical practice, clinical care pathways, and treatment options. Conclusion: The present Delphi consensus provides evidence-based recommendations and protocols for the management of NOAC-associated bleeding in the region. Patients with major DOAC-induced bleeding should be referred to a well-equipped ED with standardized management protocols. A multidisciplinary approach is recommended for establishing the association between NOAC use and major bleeding. Treating physicians should have prompt access to specific reversal agents to optimize patient outcomes. Real-world evidence and national guidelines are needed to aid all stakeholders involved in NOAC-induced bleeding management. [ABSTRACT FROM AUTHOR]

Background. Home blood pressure monitoring (HBPM) is a crucial part of managing and preventing complications of hypertension. Objectives. The study’s objective was to evaluate adult hypertension patients’ knowledge of and attitudes towards home blood pressure monitoring (HBPM). However, it is uncertain whether individuals with hypertension in Saudi Arabia monitor their blood pressure at home. Material and methods. In a cross-sectional survey, a total of 830 cases, ranging from 18 years of age and above of both genders, were selected. Patients with hypertension for more than six months were included. Data was collected by filling out the designed questionnaire. Results. Knowledge related to blood pressure (BP) measurements was moderate to high, whereas the practices of home blood pressure monitoring were not satisfactory. Our results imply that patients are informed about hypertension (HTN) in general but are less aware of specific factors associated with it, specifically their own degree of BP control. There was no statistically significant association between the age of the participants, gender, educational level, occupation, residency region and the duration of HTN compared with knowledge and level of practice; however, it was observed that participants who had sufficient average monthly income, positive family history of hypertension and patients with chronic disease(s) had significantly better knowledge and good practices. Conclusions. The knowledge of hypertensive patients related to HBPM was found to be moderate, while their practices were poor. Hypertensive patients > 60 years of age showed better practices. Both knowledge and practices were comparatively better in patients who were married, those who had a sufficient monthly income, those with a family history of HTN and those who had associated comorbidities [ABSTRACT FROM AUTHOR]

Numerous agents with anxiolytic or stimulant effects have the potential to be overused, and their misuse is associated with serious side effects. In Saudi Arabia, the estimated percentage of Saudis who abuse drugs is around 7–8% and the age range is 12–22 years. Methamphetamine, captagon, tramadol, heroin, and cannabis/cannabinoids have been proven to be the most commonly abused drugs in Saudi Arabia, with methamphetamine being at the top of the list. The present study focuses on the chromatographic analytical methods used for the analysis of methamphetamine in combination with commonly abused drugs, aiming to point out the greenest among them. These mixtures have been chosen as they are analyzed periodically and frequently in criminal evidence and forensic medicine. Therefore, the chances of hazards for analysts and the environment are high if the mixtures are not handled appropriately. This study aims to compare 23 chromatographic methods used for the analysis of methamphetamine mixtures in four major combinations, and to assess their greenness by using three greenness assessment tools, namely, NEMI, ESA and AGREE, to recommend the greenest analytical method. The NEMI results were proven to have low discriminating abilities and, accordingly, the comparisons are based on ESA and AGREE scores. The analysis results show that the safest methods with the most eco-friendly results (based on ESA and AGREE) are the GC-MS method proposed by Mohammed et al. to analyze methamphetamine and captagon mixtures (ESA = 79 and AGREE = 0.57), the UHPLC–MS-MS method proposed by Busardò et al. to analyze methamphetamine and cannabis/cannabinoid mixtures (ESA = 78 and AGREE = 0.57), the LC-MS method proposed by Herrin et al. to analyze methamphetamine and tramadol mixtures (ESA = 81 and AGREE = 0.56), and the LC-MS method proposed by Postigo-et al to analyze methamphetamine and heroin mixtures (ESA = 76 and AGREE = 0.58). [ABSTRACT FROM AUTHOR]

Context: Type 2 diabetes mellitus (T2DM) is expanding at an epidemic rate. Diabetes and the prediabetes are associated with a number of skin manifestations which are seen in a minimum of 30% of diabetics as first sign or during the course of their illness. To the best of our knowledge, this is the first study in Saudi Arabia that assess physicians' knowledge, attitude and practice regarding this common problem. Aims: To assess the level of knowledge, attitude, and practice (KAP) about diabetic dermopathy among a representative sample of physicians in Saudi Arabia; and to identify determinants of good KAP. Settings and Design: A cross-sectional study was conducted among physicians at university and governmental hospitals in Riyadh, KSA Materials and Methods: 112 physicians from different specialties and experiences were interviewed using an English self-administered questionnaire. Statistical analysis used: Data was analyzed using IBM SPSS Statistics for Windows, version 20, with appropriate statistical test. P value < 0.05 was considered significant. Results: It included 112 physicians in which 43.8%, Family medicine, 31.3% endocrinologist/Internal Medicine, and 25.0% GPs/Interns. Physicians above 35 year-old, master/PhD holders, consultants, endocrinologist/Internal Medicine, and those in practice for more than 10 years scored the highest in the overall knowledge. However, only 47% were confident to diagnose diabetic dermopathy. Moreover, majority of physicians regardless of the specialty, had educated their patients, examined them for other lesions, and followed conservative protocols. As much as 74.3% of endocrinologists seek for dermatologists' consultation. Conclusions: Physicians' knowledge regarding diabetic dermopathy is suboptimal, this may impact quality of diabetes care. [ABSTRACT FROM AUTHOR]

Background: The economic transition in Saudi Arabia imposed negative consequences leading to an increase in the prevalence of obesity and its sequelae. Despite the commitment of high authorities in KSA to combat obesity, so far 25% of Saudis are still obese. The association between obesity, disordered eating attitude, and body image needs to be addressed. Aim: To explore the relationship between obesity, eating attitude, and body image satisfaction among students and employees at Princess Nourah University (PNU) and to compare the different modalities of assessing body weight. Methods: A cross-sectional study using a convenient sampling technique comprised of 550 participants. Obesity was assessed by anthropometric measurements and body composition monitor (BF511). Eating attitude test (EAT26) was used to determine eating attitude while body image satisfaction score was determined using body shape questionnaire (BSQ). Results: Around 382 (69.5%) students and 168 employees participated in the study. Obesity was significantly higher among employees (48.2%) vs students (27.7%) (P < 0.001). Body fat composition showed significant positive correlations ranging from weak-to-moderate (0.13 to 0.44) with other body measurements for students and employees. The disordered eating attitude was maximized among obese compared to other BMI groups (P < 0.05). Percentage of disordered eating attitude score correlated positively with BMI: 35.2% vs 52.3% among underweight and obese, respectively (P = 0.001). There was no statistical difference in eating attitudes between students and employees. BSQ score correlates positively with BMI (P < 0.001), it was 36.73 ± 18.68 vs 57.92 ± 18.50 for underweight and obese, respectively. The effect of BMI on body image score was 19.1%. Discussion and Conclusion: Obesity remains a significant health problem among Saudi females. Increased BMI is associated with increased disordered food attitude and the effect of BMI on body image score was minimal. [ABSTRACT FROM AUTHOR]

Empathy is the fundamental substructure of moral behavior. Skillful clinicians may not necessarily be successful dentists if they do not have sufficient empathy. The aim of this study was to assess the level of empathy among dental students at King Abdulaziz University with an emphasis on the effect of gender and study level. A cross-sectional study was carried out among third- to sixth-year dental students of King Abdulaziz University in Jeddah, Saudi Arabia. A validated, self-administered Jefferson Scale of Empathy-Health Care Provider Student Version was distributed in academic year 2016-17 to all 380 students in the third to sixth years. A total of 300 students responded, for a response rate of 78.9%. The results showed that the students' mean empathy score was 84.84±11.28 on a range from 20 to 140. The fifth- and sixth-year students had higher scores than the third- and fourth-year students although the differences were not statistically significant. The mean empathy score of women students was significantly higher (p<0.001) than that of men students, and the women demonstrated significantly better perspective-taking (p<0.001) than the men. This study found that the students were empathetic and had a sense of moral obligation although their mean empathy score was not as high as expected. Integrating empathic, ethical, and professional elements into the dental curriculum is needed. [ABSTRACT FROM AUTHOR]

Medicinal plants have a great role in influencing health all over the world. There are few studies for the phytochemical investigations in medicinal plants were conducted in Saudi Arabia especially in Albaha region in south-western Saudi Arabia. Therefore this study focused on the detection of the phytochemical composition of the most dominant eighteen natural medicinal plant varieties found in Albaha region. Aqueous extracts of the dried aerial parts of these plants were prepared. The phytochemical composition of these extracts was investigated. Also, the antioxidants and anti-cancer activity of these plants' extracts were evaluated. The results revealed that phenols, flavonoids saponins and glycosides cyanides were the most abundant phytochemical components in the investigated plants. Dodonaea viscosa, Solanum incanum, Olea europaea subsp. cuspidata and Aerva javanica were the highest plants in their phytochemical components and their antioxidant capacity. Their antioxidant capacity recorded 38, 32, 22 and 14% increase more than that of the standard (Ascorbic acid) respectively. Also, these plants showed an interesting anticancer effect compared to the other studied plants. Their IC50 against studied cancer cell lines was lower than 20 μg/ml. This low IC50 is an evidence to be a promising anticancer agent for crude extracts. Thus the present study highlighted the importance of these detected plant varieties as a source of anticancer agents. More intensive studies are needed to verify the most effective chemical components in these investigated plants. • Medicinal plants have a great role in influencing health all over the world. • Saudi Arabia and the Arabian Peninsula are rich in wild and cultivated medicinal plants. • Most dominant plants in Albaha region have high content of phenols, flavonoids saponins and glycosides cyanides. • Dodonaea viscosa, Solanum incanum, and Olea europaea subsp. cuspidata can be a very promising source for anticancer agents. [ABSTRACT FROM AUTHOR]

Background: Ramadan Umrah is the second largest Islamic pilgrimage with 2.75 million pilgrims allowed in 2022. This report presents the results of a survey among Egyptian pilgrims returning from Ramadan Umrah to monitor SARS-CoV-2 and influenza activity and identify prevalent SARS-CoV-2 variants after this mass gathering., Methods: Cross-sectional survey conducted at Cairo airport from 30th April 2022-5 th May 2022. Pilgrims were invited to participate voluntarily. After consenting, participants interviewed using questionnaire including demographics, health status, and vaccination information and asked to provide NP/OP swabs for SARS-CoV-2 and influenza testing by RT-PCR. Whole-genome sequencing performed for 29 SARS-CoV-2 isolates. Incidence calculated, descriptive data analysis performed, and SARS-CoV-2 patients were compared to negatively tested participants using chi 2 and p value< 0.05., Results: Overall, 1003 subjects participated, their mean age 50.9 ± 13 years, 594 (59.2%) were males. Of them, 76(7.6%) tested positive including 67(6.7%) SARS-CoV-2, 7(0.7%) influenza and 2(0.2%) SARS-CoV-2/influenza coinfection. Omicron sublineage BA.2 was the prevalent variant with no difference in severity identified between BA.1 and BA.2. No difference was identified between COVID-19 incidence among receivers of different vaccine types or between fully vaccinated and booster dose receivers., Conclusions: Survey indicated a low incidence of SARs-CoV-2 and influenza among Egyptian pilgrims returning from Ramadan Umrah. Patients had mild or no symptoms with no hospitalization or deaths reported. Full vaccination and booster doses of COVID-19 vaccines proved equally effective. Enhancing COVID-19 and influenza vaccination before mass gatherings and close monitoring of respiratory viruses among pilgrims returning from Hajj and Umrah are crucial for outbreak early detection and mitigation., Competing Interests: Conflict of interest disclosure The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication., (Copyright © 2022. Published by Elsevier Ltd.)