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BackgroundThe COVID-19 pandemic is expected to cause significant morbidity and mortality. The development of an effective vaccine will take several months to become available, and its affordability is unpredictable. Transfusion of convalescent plasma (CP) may provide passive immunity. Based on initial data from China, a group of hematologists, infectious disease specialists, and intensivists drafted this protocol in March 2020. ObjectiveThe aim of this study is to test the feasibility, safety, and efficacy of CP in treating patients with COVID-19 across Saudi Arabia. MethodsEligible patients with COVID-19 will be recruited for CP infusion according to the inclusion criteria. As COVID-19 has proven to be a moving target as far as its management is concerned, we will use current definitions according to the Ministry of Health (MOH) guidelines for diagnosis, treatment, and recovery. All CP recipients will receive supportive management including all available recommended therapies according to the available MOH guidelines. Eligible CP donors will be patients with COVID-19 who have fully recovered from their disease according to MOH recovery criteria as detailed in the inclusion criteria. CP donors have to qualify as blood donors according to MOH regulations except for the history of COVID-19 in the recent past. We will also test the CP donors for the presence of SARS-CoV-2 antibodies by a rapid test, and aliquots will be archived for future antibody titration. Due to the perceived benefit of CP, randomization was not considered. However, we will compare the outcome of the cohort treated with CP with those who did not receive CP due to a lack of consent or lack of availability. In this national collaborative study, there is a likelihood of not finding exactly matched control group patients. Hence, we plan to perform a propensity score matching of the CP recipients with the comparator group patients for the major characteristics. We plan to collect demographic, clinical, and laboratory characteristics of both groups and compare the outcomes. A total sample size of 575 patients, 115 CP recipients and 460 matched controls (1:4 ratio), will be sufficient to detect a clinically important hospital stay and 30-day mortality difference between the two groups with 80% power and a 5% level of significance. ResultsAt present, patient recruitment is still ongoing, and the interim analysis of the first 40 patients will be shared soon. ConclusionsIn this paper, we present a protocol for a national collaborative multicenter phase II study in Saudi Arabia for assessing the feasibility, safety, and potential efficacy of CP in treating patients with severe COVID-19. We plan to publish an interim report of the first 40 CP recipients and their matched comparators soon. Trial RegistrationClinicalTrials.gov NCT04347681; https://clinicaltrials.gov/ct2/show/NCT04347681 International Registered Report Identifier (IRRID)PRR1-10.2196/23543

OBJECTIVES: The aim of this investigation was to determine the capacity of serotonin reuptake inhibitor (SSRI) antidepressant drug fluoxetine (FLX) to induce genotoxic damage in somatic and germ cells. METHODS: For this study, sister-chromatid exchanges (SCE's) in bone marrow cells and sperm abnormalities assays in male mice were used. The animals were organized in four groups constituted by five mice. They were orally administered with the test substance as follows: a negative control group; three groups treated with FLX (2.6, 7.8 and 13.0 mg/kg b.wt.) for 5 consecutive days. Animals were sacrificed 24h after the last treatment for analysis SCE's and left for 35 days from the first treatment for analysis sperm-shape abnormalities. RESULTS: The results showed that the drug was SCE and sperm abnormalities inducer. The response of this compound was dose-dependent, and showed that the highest tested dose increased about two times SCE and four times the sperm abnormalities control level. The cellular proliferation kinetics was not affected by the chemical, and the mitotic indexes were slightly diminished with the highest dose. The percentage of sperm count and sperm motility decreased (p < 0.01) with increased the dose of treatment. CONCLUSIONS: These results indicate an in vivo genotoxic potential for the antidepressant drug FLX. [ABSTRACT FROM AUTHOR]

Objective: This study investigates Saudi Arabian physiotherapists' perspectives on direct access to physiotherapy (DAPT) services, focusing on perceived benefits, barriers and implementation in clinical practice., Methods: A cross-sectional observational study design was used. Data collection occurred between December 2022 and June 2023 via an online structured questionnaire distributed through email and text messages. The DAPT section comprised items on awareness, endorsement, obstacles/barriers to implementation in Saudi Arabia, perceived benefits and expected benefits of various resources to guide evidence-based practice for physiotherapists. This section featured closed-ended questions using a 5-point Likert scale. The study included licensed physiotherapists currently working in Saudi Arabia., Results: The study included 401 participants, with a nearly equal distribution of 203 males (50.6%) and 198 females (49.4%). The most common age group was 25-34 years, comprising 70.6% of the participants. A significant proportion (61.6%) were aware of DAPT, and 88% acknowledged its potential to reduce delays in care. However, 49.9% had not engaged with relevant literature. The primary barriers to DAPT identified were laws and regulations (mean=3.69, SD=1.21), physician support (mean=3.59, SD=0.99), entry-level education (mean=3.45, SD=1.17), patient beliefs (mean=3.38, SD=1.24), self-confidence (mean=3.35, SD=1.15) and professional autonomy (mean=3.34, SD=1.22)., Conclusion: Physiotherapists in Saudi Arabia demonstrate substantial awareness of direct access. Organisational initiatives and increased awareness are essential to promote direct access. This study highlights that direct patient access to physiotherapists offers significant benefits to patients, healthcare workers and the broader community., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: To evaluate the tolerability of crovalimab versus eculizumab in C5 inhibitor (C5i)-naive and -experienced patients with PNH from COMMODORE 2, 3 and 1 (NCT04434092, NCT04654468 and NCT04432584)., Methods: Pooled safety data were assessed in the total crovalimab and eculizumab populations and by C5i-naive versus C5i-switched status in patients receiving crovalimab. Analyses include 6.5 months of additional follow-up from the COMMODORE 2 and 1 primary analyses., Results: COMMODORE safety data (crovalimab, 393 patients [naive, 192 patients; switched, 201 patients]; eculizumab, 111 patients) were analysed. The total patient years (PY) were 503.9 and 51.1 in the total crovalimab and eculizumab populations, respectively, with 471 and 581 adverse events (AEs) per 100 PY. Serious infection rates were 8.9 and 13.7 AEs per 100 PY, respectively; no meningococcal infections were reported. Fatal AEs occurred in eight (2%) patients receiving crovalimab (naive, six patients; switched, two patients) and one (1%) receiving eculizumab, all treatment unrelated. In C5i-switched patients, 39 (19%) had transient immune complex reactions (risk when switching between C5i and crovalimab); the majority were Grades 1-2 arthralgia and rash, and 16 (8%) had Grade 3 events., Conclusions: Crovalimab's safety profile was consistent with eculizumab's and was generally comparable between C5i-naive and C5i-switched patients., (© 2024 The Author(s). European Journal of Haematology published by John Wiley & Sons Ltd.)

Background: Hemophilia A presents a significant health challenge in the Gulf region, where it has an especially high prevalence. There are several unmet needs associated with the management of hemophilia A in the region. The aim of this manuscript was to contextualize unmet management needs, provide recommendations to optimize care, and specify requirements for the establishment of gene therapy centers in the region., Summary: An expert panel was assembled comprising ten clinical hematologists from Kuwait, Oman, Saudi Arabia, and the UAE. The Delphi methodology was used to obtain a consensus on statements relating to several aspects of hemophilia A. A consensus was reached for all statements by means of an online, anonymized voting system. The consensus statements pertain to screening and diagnosis, treatment approaches, and requirements for the implementation of gene therapy., Key Messages: There are significant challenges that hinder the optimal management of hemophilia A in the Gulf region. The consensus statements presented provide specific recommendations to improve diagnostic and treatment approaches, promote multidisciplinary care, and optimize regional data generation and reporting. These statements also delineate the requirements for the establishment of gene therapy centers for hemophilia A in the region., Background: Hemophilia A presents a significant health challenge in the Gulf region, where it has an especially high prevalence. There are several unmet needs associated with the management of hemophilia A in the region. The aim of this manuscript was to contextualize unmet management needs, provide recommendations to optimize care, and specify requirements for the establishment of gene therapy centers in the region., Summary: An expert panel was assembled comprising ten clinical hematologists from Kuwait, Oman, Saudi Arabia, and the UAE. The Delphi methodology was used to obtain a consensus on statements relating to several aspects of hemophilia A. A consensus was reached for all statements by means of an online, anonymized voting system. The consensus statements pertain to screening and diagnosis, treatment approaches, and requirements for the implementation of gene therapy., Key Messages: There are significant challenges that hinder the optimal management of hemophilia A in the Gulf region. The consensus statements presented provide specific recommendations to improve diagnostic and treatment approaches, promote multidisciplinary care, and optimize regional data generation and reporting. These statements also delineate the requirements for the establishment of gene therapy centers for hemophilia A in the region., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Purpose: This study aimed to translate, cross-culturally adapt, and validate the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care into Arabic (MRPS-Ar)., Materials and Methods: The 20-Item MRPS was translated and cross-culturally adapted into Arabic following international guidelines. Patients ( n  = 229) with musculoskeletal conditions who received physical therapy care completed the MRPS-Ar and global rating of change scale. Of these patients, 95 completed the MRPS-Ar twice. Factor structure, floor and ceiling effects, internal consistency, test-retest reliability, and construct validity of the MRPS-Ar were evaluated., Results: Principal component analysis suggested 3-factor solution: a 7-item facility experience, 6-item therapeutic experience, and 3-item positive experience. The MRPS-Ar and its factors showed acceptable internal consistency (Cronbach's alpha coefficients ranged from 0.819 to 0.936) and excellent test-retest reliability (ICCs ranged from 0.965 to 0.983). The global measures of satisfaction were significantly correlated with the global rating of change (Spearman's rho = -0.678, p  < 0.001 for item "overall satisfaction" and Spearman's rho = -0.690, p  < 0.001 for item "would return")., Conclusions: The 18-item MRPS-Ar displayed adequate psychometric properties for measuring patients' satisfaction with physical therapy care. The MRPS-Ar is a reliable and valid instrument that can be used in medical, clinical, and research fields.

Chemotherapy-induced cytopenia (CIC) is characterized by neutropenia, anemia, and thrombocytopenia, which are common and serious complications in cancer treatment. These conditions affect approximately 60% of patients undergoing chemotherapy and can significantly impact quality of life, treatment continuity, and overall survival. The use of growth factors, including granulocyte colony-stimulating factors (GCSFs), erythropoietin-stimulating agents (ESAs), and thrombopoietin receptor agonists (TPO-RAs), has emerged as a promising strategy for managing CIC. However, the use of these growth factors must be approached with caution. This review provides an overview of the mechanisms, efficacy, and safety of growth factors in the management of CIC. Additionally, we discuss predictive markers for treatment response, potential risks, and highlight areas for future research.

Helicobacter pylori ( H. pylori ) is a Gram-negative, spiral-shaped bacterium that colonizes the gastric epithelium and is associated with a range of gastrointestinal disorders, exhibiting a global prevalence of approximately 50%. Despite the availability of treatment options, H. pylori frequently reemerges and demonstrates increasing antibiotic resistance, which diminishes the efficacy of conventional therapies. Consequently, it is imperative to explore non-antibiotic treatment alternatives to mitigate the inappropriate use of antibiotics. This review examines H. pylori infection, encompassing transmission pathways, treatment modalities, antibiotic resistance, and eradication strategies. Additionally, it discusses alternative therapeutic approaches such as probiotics, anti-biofilm agents, phytotherapy, phototherapy, phage therapy, lactoferrin therapy, and vaccine development. These strategies aim to reduce antimicrobial resistance and enhance treatment outcomes for H. pylori infections. While alternative therapies can maintain low bacterial levels, they do not achieve complete eradication of H. pylori . These therapies are designed to bolster the immune response, minimize side effects, and provide gastroprotective benefits, rendering them suitable for adjunctive use alongside conventional treatments. Probiotics may serve as adjunctive therapy for H. pylori ; however, their effectiveness as a monotherapy is limited. Photodynamic and phage therapies exhibit potential in targeting H. pylori infections, including those caused by drug-resistant strains, without the use of antibiotics. The development of a reliable vaccine is also critical for the eradication of H. pylori . This review identifies candidate antigens such as VacA , CagA , and HspA , along with various vaccine formulations, including vector-based and subunit vaccines. Some vaccines have demonstrated efficacy in clinical trials, while others have shown robust immune protection in preclinical studies. Nevertheless, each of the aforementioned alternative therapies requires thorough preclinical and clinical evaluation to ascertain their efficacy, side effects, cost-effectiveness, and patient compliance.

Background: Bipolar disorder (BD) is a chronic mental health condition that significantly affects an individual's quality of life (QoL). While previous research has primarily concentrated on the clinical aspects of BD, there is increasing interest in understanding the factors associated with QoL in this population. This cross-sectional study aimed to assess the effects of different coping strategies on the overall QoL of individuals with BD, encompassing the physical, psychological, and social dimensions, while comparing adaptive and maladaptive coping strategies. The study sample included 96 outpatients diagnosed with BD recruited from psychiatric outpatient clinics in Riyadh and Dammam, Saudi Arabia, as well as a broader BD community. Participants completed the World Health Organization Quality of Life Brief questionnaire (WHOQOL-BREF) and Coping Orientation to Problems Experienced (Brief-COPE) questionnaires., Results: The findings indicated that problem-focused coping strategies, such as seeking support and taking direct action to manage stress, were associated with better QoL among individuals with bipolar disorder. In contrast, emotion-focused strategies such as self-blame are linked to lower QoL., Conclusion: These results contribute to the limited research on QoL in BD, particularly in Arab and Saudi societies, and underscore the need for targeted interventions aimed at developing effective coping mechanisms to enhance the wellbeing of individuals with BD., Competing Interests: The author declares 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 Alzahrani.)

Vitamin B12 is significant for DNA synthesis, red blood cell formation, and nervous system function. Inadequate vitamin B12 levels may result in a higher risk of depression, necessitating the need for supplementation to improve mood and cognitive function. However, the use of vitamin B12 supplementation varies across studies. This review aims to evaluate the effect of vitamin B12 supplementation on cognitive memory function and depressive symptoms among participants who may have mild cognitive impairment (MCI). This review adhered to the Cochrane Handbook and PRISMA guidelines. A comprehensive search was conducted across PubMed, CENTRAL, Medline, and Ovid, with no constraints on geography or demographics, up to August 31, 2024. Only randomized controlled trials (RCTs) were included. Data on study characteristics, treatment details, and outcomes were extracted. The risk of bias was assessed using the revised Cochrane ROB2 tool. A meta-analysis of the effect of vitamin B12 on cognitive memory and depression was conducted using Jamovi software (The jamovi project (2024). jamovi (Version 2.5) [Computer Software]. Retrieved from https://www.jamovi.org). Statistical significance was set at p < 0.05. The results yielded 483 records that were screened based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Excluding duplicates and irrelevant studies, the meta-analysis finally included nine RCTs. For cognitive memory function, eight of the nine included studies were analyzed, showing an average standardized mean difference of -0.03 (95% confidence interval (CI): -0.07 to 0.01), indicating no significant effect of vitamin B12 supplementation (p = 0.1801) and no significant heterogeneity. Regarding depressive symptoms, three of the nine included studies were analyzed, yielding an average standardized mean difference of -0.01 (95% CI: -0.0773 to 0.0525), also showing no significant effect (p = 0.708). These results suggest that vitamin B12 complex supplementation has an insignificant effect on cognitive function and depressive symptoms in the general population. However, further research is needed to explore the conditions under which B12 is most effective, providing clearer guidelines for its use in clinical practice., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alzahrani et al.)

Aim: The current umbrella review aimed to summarize the effect of erbium-doped yttrium aluminum garnet (Er: YAG) laser adjunct with the conventional non-surgical periodontal treatment which was evidenced from available systematic reviews., Methods: An extensive literature search was piloted by two independent reviewers in the PubMed, Scopus, Science Direct, and Google Scholar databases. The search was limited to the English language from 2011 to 2023 years. The methodological quality of systematic reviews 2 (AMSTAR 2) guideline was followed to evaluate the risk of bias for the selected studies. Cohen's kappa statistic was implemented to evaluate the level of agreement to assess the risk of bias in the selected studies., Results: A total of 472 studies were initially identified. After removing the duplicates and screening, a total of four studies were selected for the current overview. Based on the quality assessment tool, each study scored as high, moderate, low, and critically low-quality study following AMSTAR 2 tool. Inter-rater reliability by Cohen's Kappa statistics showed near-perfect agreement (0.95) between the two reviewers., Conclusion: Even though weak evidence of effectiveness was observed for Er: YAG laser application in non-surgical periodontal treatment, the clinical benefits are still lacking., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Myofascial pain syndrome (MPS) is a chronic condition caused by sensitive pressure regions within the muscles known as myofascial trigger points (MTrPs)., Objective: The purpose of this randomized controlled trial (RCT) was to assess the effectiveness of adding dry needling (DN) to activate MTrPs in the upper trapezius muscle compared with usual physiotherapy among individuals with chronic neck pain., Methods: Thirty participants were recruited from a private clinic in Saudi Arabia. Their mean age was 29.7 ± 4.4 years. The subjects were randomized into two groups: the experimental group (application of DN to the MTrPs coupled with usual physiotherapy (n = 15)) and the control group (usual physiotherapy alone (n = 15)). The primary outcomes were pain (assessed using the visual analog scale) and disability (Neck Disability Index), and the secondary outcomes were neck active range of motion (AROM; assessed using cervical ROM) and depression (Beck's Depression Inventory)., Results: Significant between-group difference in pain intensity was observed immediately post-intervention. Participants in the experimental group had significantly higher pain (mean difference = 1.27, 95% confidence interval [CI] 0.20, 2.33, p = 0.022, Cohen's d = 0.889) than those in the control group. There was no significant difference between both groups in pain intensity during the follow-up. There were no between-group differences in disability immediately post-intervention. However, there was a between-group difference in disability at follow-up; participants in the experimental group had significantly lower disability (mean difference = -3.13, 95%CI -5.07, -1.20, p = 0.003, Cohen's d = 1.211) than those in the control group. Immediately post-intervention, the experimental group showed greater flexion AROM compared to the control group, with no differences in other AROM measures. At follow-up, the experimental group exhibited significantly higher neck AROM in extension, flexion, right and left side bending, and lower depression, while no differences were observed in right- and left-rotation AROMs between groups., Conclusions: The addition of DN to standard physiotherapy effectively improved disability, AROM (extension, flexion, and side bending), and depression among patients with chronic neck pain., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The Central Sensitization Inventory (CSI) is a patient-reported screening instrument that can be used to identify and assess central sensitization (CS)/Central Sensitization Syndrome (CSS)-related symptoms., Objective: The aim was to translate the CSI into Arabic (CSI-Ar) and to subsequently validate its psychometric properties., Design: Cross-sectional., Methods: The CSI was translated and cross-culturally adapted into Arabic, and validated following international standardized guidelines. This study included patients with chronic musculoskeletal pain ( n = 264) and healthy control participants ( n = 56). Patients completed the CSI-Ar, Pain Catastrophizing Scale (PCS), Depression, Anxiety, and Stress scale (DASS-21), Tampa Scale of Kinesiophobia (TSK), and 5-level EuroQol-5D (EQ-5D). Patients completed the CSI-Ar twice to assess test-retest reliability. To evaluate discriminative validity, healthy controls participants completed the CSI-Ar. Statistical analyses were conducted to test the internal consistency, reliability, and structural, construct and discriminant validity of CSI-Ar., Results: The CSI-Ar showed acceptable internal consistency (Cronbach's alpha = 0.919) and excellent test-retest reliability (intraclass correlation coefficient = 0.874). The CSI-Ar scale had significant correlations ( P < 0.001) with all PCS subscales and total score (Spearman's rho = 0.459-0.563, P < 0.001), all DASS-21 subscales and total score (Spearman's rho = 0.599-0.685, P < 0.001), the TSK (Spearman's rho = 0.395, P < 0.001), and the EQ-5D (Spearman's rho = -0.396, P < 0.001). The Mann-Whitney U-test showed a statistically significant difference between the patient group and the healthy control group ( P < 0.001), with the healthy controls displaying a lower average CSI-Ar score (12.27 ± 11.50) when compared to the patient group (27.97 ± 16.08). Factor analysis indicated that the CSI-Ar is a unidimensional tool., Conclusion: The CSI-Ar is a reliable and valid screening tool that can be used to assess CS/CSS-related symptoms in Arabic-speaking people with chronic musculoskeletal pain., Competing Interests: The authors declare that they have no competing interests., (© 2024 Tamboosi et al.)

Acquired factor XIII (FXIII) deficiency is a rare disorder that could be associated with autoimmune and malignant disorders with a high risk of bleeding. In acute leukemias, acquired FXIII deficiency has been reported and replacement of FXIII helped to control significant bleeding. Here, we report four cases of myeloid neoplasms to have acquired FXIII deficiency with interesting concomitant RUNX1 mutation in the molecular background of two patients. Correction of bleeding complications was successful in all patients with FXIII substitution by FXIII concentrate in three patients and cryoprecipitate in one patient. Studying the association of FXIII deficiency with molecular abnormalities in such neoplasms is needed for better understanding and detection of common pathophysiologic pathways. This could help to avoid severe bleeding during diagnostic or therapeutic interventions in patients at risk., (Copyright © 2025 Hematology/Oncology and Stem Cell Therapy.)

Case Presentation: A 15-year-old girl presented to her local hospital with a 4-month history of fatigue, anorexia, and a 6-kg weight loss. She also reported fever, productive cough, and chest pain on the left lower chest posteriorly for 4 days before admission. Her medical history and systemic review were unremarkable for any respiratory or other organ disease. The patient was taking iron and multivitamin supplements. At her local hospital, she was febrile; chest radiography showed anemia and a left lower lobe infiltrate. She received a transfusion and was started on empiric antibiotics that were continued for 10 days without improvement. Subsequently, CT scan of the chest and upper abdomen showed a lung abscess and left renal mass that led to a referral to our center., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) are a novel class of medications promising for treating type 2 diabetes mellitus (T2DM) and obesity-related conditions such as cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD). This comprehensive literature review examines available research on these medications, focusing on their mechanisms of action, clinical effectiveness, safety profiles, and socioeconomic implications. A comprehensive search was performed using the PubMed, EMBASE, and Cochrane Library databases. Although initially developed for glucose management, these drugs have also demonstrated efficacy in promoting weight loss and reducing the risk of CVD. GLP-1-RAs function similarly to naturally occurring incretins. They stimulate insulin secretion in response to glucose levels, inhibit glucagon release, delay stomach emptying, and generate a sense of fullness via brain pathways. Head-to-head clinical studies have indicated that GLP-1-RAs outperform conventional antidiabetic medicines in terms of glycemic management and weight reduction. According to cardiovascular outcome studies, various drugs in this category have been found to reduce the frequency of severe adverse cardiovascular events. A common side effect is gastrointestinal toxicity, which can be mitigated by gradually increasing the dose. Personalized treatment is likely because the effectiveness, safety, and dose regimens of currently available GLP-1-RAs differ. GLP-1-RAs are a superior choice for patients with T2DM, especially those who already have CVD or require weight-control support. The high cost of these drugs creates hurdles to access and fair healthcare. Current research mainly focuses on increasing therapeutic uses and producing orally delivered medicines with greater potency and bioavailability. Integrating GLP-1-RAs into clinical practice can enhance patient outcomes and reduce the community burden of cardiometabolic disease., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hamed et al.)

The neurometabolic disorder known as biotin-thiamine-responsive basal ganglia disease (BTBGD) is a rare autosomal recessive condition linked to bi-allelic pathogenic mutations in the SLC19A3 gene. BTBGD is characterized by progressive encephalopathy, confusion, seizures, dysarthria, dystonia, and severe disabilities. Diagnosis is difficult due to the disease's rare nature and diverse clinical characteristics. The primary treatment for BTBGD at this time is thiamine and biotin supplementation, while its long-term effectiveness is still being investigated. In this study, we have generated two clones of induced pluripotent stem cells (iPSCs) from a 10-year-old female BTBGD patient carrying a homozygous mutation for the pathogenic variant in exon 5 of the SLC19A3 gene, c.1264A > G (p.Thr422Ala). We have confirmed the pluripotency of the generated iPS lines and successfully differentiated them to neural progenitors. Because our understanding of genotype-phenotype correlations in BTBGD is limited, the establishment of BTBGD-iPSC lines with a homozygous SLC19A3 mutation provides a valuable cellular model to explore the molecular mechanisms underlying SLC19A3-associated cellular dysfunction. This model holds potential for advancing the development of novel therapeutic strategies., (© 2024. The Author(s).)

Soil contamination is a major issue that endangers the ecology in most countries. Total concentrations of As, Cd, Co, Cr, Cu, Mn, Ni, Pb, VFe, and Zn were determined by analyzing soil samples from 32 surface soil samples in southwest Saudi Arabia, including certain areas of Al-Baha. Kriging techniques were used to create maps of the distribution of metal. To assess the levels of soil contamination in the research area, principal component analysis (PCA), contamination factors (CF), and pollution load index were used. The results show the stable model gave the best fit to the As and Zn semivariograms. The circular model fits the Cd, Co, and Ni semivariograms the best, while the exponential model fits the Cr, V, and Fe semivariograms the best. For Ni and Pb, respectively, spherical and Gaussian models are fitted. The findings demonstrated two clusters containing different soil heavy metal concentrations. According to the data, there were two different pollution levels in the research region: 36.58% of it is strongly contaminated, while 63.41% of it has a moderate level of contamination (with average levels of these metals 5.28 ± 5.83, 0.81 ± 0.19, 18.65 ± 6.22, 45.15 ± 23.25, 60.55 ± 23.74, 972.30 ± 223.50, 33.45 ± 14.11, 10.05 ± 5.13, 84.15 ± 30.72, 97.40 ± 30.05, and 43,245.00 ± 8942.95 mg kg -1 for As, Cd, Co, Cr, Cu, Mn, Ni, Pb, V, Fe, and Zn, respectively). The research area's poor management practices are reflected in the current results, which raised the concentration of harmful elements in the soil's surface layers. Ultimately, the outcomes of pollution concentration and spatial distribution maps could aid in informing decision-makers when creating suitable heavy metal mitigation strategies.

Owing to the high cost of precious metal catalysts for the oxygen evolution reaction (OER), the production of highly efficient and affordable electrocatalysts is important for generating pollution-free and renewable energy via electrochemical processes. A facile hydrothermal approach was employed to synthesize hybrid mesoporous iron-nickel bimetallic sulfides @ P, N-doped carbon for the OER. The prepared Fe 0.5 NiS 2 @C exhibited an overpotential (η) of 250 mV at 10 mA/cm 2 . This exceeded the overpotentials recently reported for surface-modified P, N-doped carbon-based catalysts for the OER in a 1 M KOH medium. Moreover, the Fe 0.5 NiS 2 @C catalyst showed a notable Tafel slope of 90.5 mV/dec with long-dated stability even after 24 h at 10 mA/cm 2 . The superior OER performance of the Fe 0.5 NiS 2 @C catalysts may be due to their large surface area, sheet-like morphology with abundant active sites, fast transfer of mass and electrons, control of the electronic structure by co-treatment with heteroatoms (e.g., P and N), and the synergistic effect of bimetallic sulfides, making them favorable catalysts for the oxygen evolution reaction. Density functional theory (DFT) calculations showed that the Fe 0.5 NiS 2 @C catalyst exhibited strong H 2 O-adsorption energy. The enhanced OER activity of Fe 0.5 NiS 2 @C was attributed to its higher surface area, favorable H 2 O adsorption energy, improved electron transfer efficiency, and lower Gibbs free energy compared to those of the other proposed catalysts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

The northern Red Sea (NRS) is considered an extended continental region that has resulted in a rift system. Gravity and bathymetry data were used to estimate the Moho depth and the elastic thickness Te of the lithosphere beneath the NRS region to characterize its flexural rigidity and understand its mechanical behavior. Focusing on the Mabahiss Deep in NRS, we analyzed the lithosphere's flexural rigidity. The observed long-wavelength positive Bouguer anomaly is attributed to crustal thinning and lithospheric mantle uplift. The crustal thickness varies from 28 km in coastal areas to 24 km beneath the axial rift, supporting a regional compensation model over the Airy model. Forward modeling suggests that the optimal model explaining the regional Bouguer anomaly is a flexural model with Te equal to 7 km, indicating a weak and irregular continental crust. The primary factor contributing to this weakness is heating activity. Given the weakened state of the crust and the ongoing extension in the region, the NRS rift could evolve into a rupture, potentially leading to the formation of oceanic crust., (© 2024. The Author(s).)

Introduction Pyruvate kinase deficiency (PKD) is a rare autosomal recessive disorder characterized by mutations in the PKLR gene, causing impaired glycolysis in red blood cells and leading to diverse clinical manifestations. The prevalence of PKD in Saudi Arabia remains understudied, particularly in the context of consanguinity and non-specialized medical facilities. Methods We conducted a retrospective analysis of seven PKD patients of Arab ethnicity, focusing on demographics, medical history, clinical features, laboratory results, treatments, and outcomes. Results Our patient cohort comprised five males and two females, aged 10 to 38 years, of Arab ethnicity. Consanguinity was prevalent, and hereditary connections were identified in five patients. PKD exhibited varying clinical presentations, with early-onset symptoms including neonatal jaundice and symptomatic anemia. One patient experienced severe hepatic disease progression leading to multiorgan failure. Blood transfusions were universally required, indicating the severity of the disorder. Anemia severity varied among patients, with diverse hematological irregularities. Splenectomy was performed for most patients, improving hemoglobin levels and transfusion needs in some cases. Iron chelation was administered, although iron overload persisted. Thrombocytosis and venous thromboembolism were observed post splenectomy. Jaundice and gallstones were common, leading to cholecystectomy. Laboratory findings remained consistent, with heightened reticulocyte counts and altered enzyme levels. Discussion PKD is a rare disorder characterized by diverse clinical manifestations. Prevalence estimation is complex due to various factors, and its diagnosis is challenged by clinical similarities with other disorders. Our cohort exhibited a spectrum of complications, highlighting the necessity for tailored interventions. Iron overload remained a concern, necessitating continuous monitoring. Although endocrine disorders and osteoporosis were absent in our cohort, vigilance is essential due to the disease's progressive nature. Genetic factors were prominent, supporting the genetic basis of PKD. Splenectomy improved anemia but had a limited impact on gallstones. Iron overload management and bone health remain crucial considerations. Conclusion This study offers comprehensive insights into the clinical and demographic characteristics of PKD patients, illustrating the complex nature of the disorder. The findings underscore the need for personalized management strategies and vigilant monitoring to address the diverse clinical manifestations and challenges associated with PKD., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Nasiri et al.)

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 Delphi-based 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., Competing Interests: Competing interests: The authors declare no conflict of Interest.

Establishing preventive measures and treatment strategies for adolescents with low back pain (LBP) may be greatly enhanced by fully grasping the complex interaction between LBP and lifestyle behaviors. The key objective of this study was to explore the possible associations between lifestyle behaviors and LBP among adolescents in Saudi Arabia. A cross-sectional study was conducted among high school students from 5 major regions in Saudi Arabia. Participants were enlisted for the research project between May and November 2021. To evaluate the presence/severity of LBP, physical activity, sedentary duration, sleep quality, nutrition, health responsibility, interpersonal relationships, spiritual growth, and stress management, a well-established web-based survey was employed. A total of 2000 students participated, with 57.9% reporting LBP. Students with LBP had lower scores on overall health-promoting lifestyle behaviors and all subscales, including physical activity, compared to those without LBP. Linear regression analysis revealed significant associations between sedentary duration and global sleep quality with pain severity among students with LBP. This study highlights the association between lifestyle behaviors and LBP among adolescents in Saudi Arabia. Promoting physical activity, reducing sedentary behavior, and improving sleep quality may be crucial in preventing and managing LBP in this population. Comprehensive strategies targeting lifestyle behaviors should be implemented to improve the well-being of adolescents and reduce the burden of LBP. Further research is needed to better understand the underlying mechanisms and develop effective preventive and treatment strategies for LBP among adolescents., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background and Objectives: Prognostic factors reliably predicting outcomes for critically ill adolescent and young adult (AYA) patients undergoing allogeneic hematopoietic cell transplantation (allo-HSCT) are lacking. We assessed transplant and intensive care unit (ICU)-related factors impacting patient outcomes., Patients and Methods: AYA patients who underwent allo-HSCT and required ICU admission at a Tertiary care Centre, during the period of 2003-2013, were included in this retrospective review. This was a non-interventional study. Only outcomes after the first allo-HSCT and index ICU admissions were analyzed. Disease-, transplant-, and ICU-related variables were analyzed to identify risk factors predictive of survival., Results: Overall, 152 patients were included (males, 60.5%); median age at transplantation was 24 years (interquartile range [IQR] 18-32.5); median age at admission to the ICU was 25.8 years (IQR 19-34). Eighty-four percent underwent transplantation for a hematological malignancy; 129 (85%) received myeloablative conditioning. Seventy-one percent of ICU admissions occurred within the first year after allo-HSCT. ICU admission was primarily due to respiratory failure (47.3%) and sepsis (43.4%). One hundred and three patients (68%) died within 28 days of ICU admission. The 1- and 5-year overall survival rates were 19% and 17%, respectively. Main causes for ICU-related death were refractory septic shock with multiorgan failure (n = 49, 32%) and acute respiratory distress syndrome (ARDS) (n = 39, 26%). Univariate analysis showed that ICU mortality was associated with an Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, a sequential organ failure assessment (SOFA score) > 12, a high lactate level, anemia, thrombocytopenia, leukopenia, hyperbilirubinemia, a high international normalized ratio (INR) and acute graft-versus-host disease (GVHD). Multivariate analysis identified thrombocytopenia, high INR, and acute GVHD as independent predictors of mortality., Conclusions: In AYA allo-HSCT patients admitted to the ICU, mortality remains high. Higher SOFA and APACHE scores, the need for organ support, thrombocytopenia, coagulopathy, and acute GVHD predict poor outcomes.

The most prevalent form of epileptic encephalopathy is Dravet syndrome (DRVT), which is triggered by the pathogenic variant SCN1A in 80% of cases. iPSCs with different SCN1A mutations have been constructed by several groups to model DRVT syndrome. However, no studies involving DRVT-iPSCs with rare genetic variants have been conducted. Here, we established two DRVT-iPSC lines harboring a homozygous mutation in the CPLX1 gene and heterozygous mutation in SCN9A gene. Therefore, the derivation of these iPSC lines provides a unique cellular platform to dissect the molecular mechanisms underlying the cellular dysfunctions consequent to CPLX1 and SCN9A mutations., (© 2023. The Author(s).)

Haploidentical donor (haplo-) hematopoietic stem cell transplantation (HSCT) with post-transplantation cyclophosphamide (PTCy) is now performed on a large scale worldwide. Our patient outcomes did not completely reflect the results published by other groups. We herein present the results of 60 patients with hematologic malignancies treated homogeneously on a modified version of the standard protocol by adding ATG as an additional graft-versus-host disease (GVHD) prophylaxis measure. This was a retrospective analysis of 60 haplo-HSCT recipients using a myeloablative conditioning regimen with antithymocyte globulin and PTCy for GVHD prophylaxis. At 5 years, overall survival was 59.2%, relapse-free survival (RFS) was 48.6%, and chronic GVHD (cGVHD) and relapse-free survival was 40%. The median time to neutrophil and platelet engraftment was 16 days and 28.5 days, respectively. The rates of grade II-IV acute GVHD and extensive cGVHD were 46.7% and 23.3%, respectively. The cumulative incidence of relapse was 30%, nonrelapse mortality was 21.6%, and transplantation-related mortality was 11%. Higher Disease Risk Index and 50% HLA match were associated with lower RFS. Female donor to male recipient and older donor age were associated with an elevated risk of cGVHD. The use of PTCy might not yield the same results in different populations. Many remaining questions need to be addressed in randomized trials, including optimal graft source and donor, date of calcineurin inhibitor initiation, personalized or targeted dose of PTCy, immune reconstitution, and others., (Copyright © 2024 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Introduction Advancements in radiological imaging technology have increased the discovery of adrenal incidentalomas. Large adrenal tumors (LATs) are not common, and the likelihood of malignancy increases with tumor size. LATs were defined as tumors larger than four centimeters (cm) with various pathologic diagnoses. Traditionally, open adrenalectomy was considered the gold standard for LATs, but with recent advancements in minimally invasive surgery (MIS), optimum perioperative and long-term outcomes are achievable by the MIS approach.   The findings presented in this paper show that even large adrenal masses measuring up to 21 centimeters can be safely removed using a minimally invasive approach. Methodology After Institutional Review Board (IRB) approval, we reviewed medical records of adult patients who had adrenalectomies at two Saudi Arabian centers from January 2013 to February 2023. Inclusion criteria were laparoscopic or robotic adrenalectomy and adrenal lesions ≥5cm. Pediatric patients and those with open adrenalectomies were excluded. Pre-surgery, patients had imaging studies to assess mass characteristics. Pheochromocytoma patients received a 2-week adrenergic blocker treatment. Perioperative data including demographics, comorbidities, mass characteristics, surgery details, and follow-up were analyzed using SPSS-23. Patients provided informed consent and had follow-up appointments and imaging. Results Our experience involved 35 patients, 29 of whom received laparoscopic treatment and six of whom underwent robotic surgery. Of the 35 patients, more than half were females (57.1%), with a mean age of 41.7±14.9 years, the youngest and oldest participants being 16 and 73 years of age, respectively. The mean body mass index (BMI) of the participants was in the overweight range (26±6.0 kg/m 2 ). The most common mode of presentation was incidental (42.9%), followed by hypertension (17.1%). Most patients had right-sided adrenal gland involvement (48.6%), with only four patients showing bilateral involvement. Most of the patients were classified as American Society of Anesthesiology score (ASA) 2 (40.0%) or ASA 3 (40.0%). Most of the patients were diagnosed with myelolipoma or adenoma (22.9% each) followed by pheochromocytoma (17.1%). The average estimated blood loss (EBL) was 189.3±354.6 ml for patients who underwent laparoscopic surgery and 80.0 ±34.6 ml for patients who underwent robotic surgery. The average operative room time (ORT) was 220.1±98.7 minutes (min) for laparoscopic surgery and 188.3±10.3 min for robotic surgery. One patient had to be converted from laparoscopic to open surgery due to aortic injury. The average length of stay (LOS) was 9.5±6.7 days for laparoscopic treatment and 5.5±1.9 days for robotic surgery. The mean tumor size in the greatest dimension was 8.0±4.4 cm. Only one patient who underwent unilateral laparoscopy experienced perioperative complications and converted to open surgery; nine patients who underwent unilateral laparoscopy required blood transfusion, and none of the patients who underwent robotic surgery required transfusion. None of the 35 patients experienced a recurrence of their adrenal disease during the mean follow-up period which lasted around 58 months. Conclusion MIS in Saudi Arabia is growing and is a safe method for LATs, with satisfactory surgical results compared to the traditional open surgery approach. It offers advantages in terms of EBL, complications, and disease recurrence., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Azhar et al.)

The genus Enterobacter belongs to the ESKAPE group, which includes Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. This group is characterized by the development of resistance to various antibiotics. In recent years, Enterobacter cloacae (E. cloacae) has emerged as a clinically important pathogen responsible for a wide range of healthcare-associated illnesses. Identifying Enterobacter species can be challenging due to their similar phenotypic characteristics. The emergence of multidrug-resistant E. cloacae is also a significant problem in healthcare settings. Therefore, our study aimed to identify and differentiate E. cloacae using Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) as a fast and precise proteomic analytical technique. We also tested hospital-acquired E. cloacae isolates that produce Extended-spectrum beta-lactamases (ESBL) against commonly used antibiotics for treating urinary tract infections (UTIs). We used a total of 189 E. cloacae isolates from 2300 urine samples of patients with UTIs in our investigation. We employed culturing techniques, as well as the BD Phoenix™ automated identification system (Becton, Dickinson) and Analytical Profile Index (API) system for the biochemical identification of E. cloacae isolates. We used the MALDI Biotyper (MBT) device for peptide mass fingerprinting analysis of all isolates. We utilized the single peak intensities and Principal Component Analysis (PCA) created by MBT Compass software to discriminate and cluster the E. cloacae isolates. Additionally, we evaluated the sensitivity and resistance of ESBL-E. cloacae isolates using the Kirby Bauer method. Out of the 189 E. cloacae isolates, the BD Phoenix system correctly identified 180 (95.24%) isolates, while the API system correctly identified 165 (87.30%) isolates. However, the MBT accurately identified 185 (98.95%) isolates with a score of 2.00 or higher. PCA positively discriminated the identified E. cloacae isolates into one group, and prominent peaks were noticed between 4230 mass-to-charge ratio (m/z) and 8500 m/z. The ESBL-E. cloacae isolates exhibited a higher degree of resistance to ampicillin, amoxicillin-clavulanate, cephalothin, cefuroxime, and cefoxitin. Several isolates were susceptible to carbapenems (meropenem, imipenem, and ertapenem); however, potential future resistance against carbapenems should be taken into consideration. In conclusion, MALDI-TOF MS is a powerful and precise technology that can be routinely used to recognize and differentiate various pathogens in clinical samples. Additionally, the growing antimicrobial resistance of this bacterium may pose a significant risk to human health., (© 2024. The Author(s).)

Introduction: Sitting on an unstable surface is a common paradigm to investigate trunk postural control among individuals with low back pain (LBP), by minimizing the influence lower extremities on balance control. Outcomes of many small studies are inconsistent (e.g., some find differences between groups while others do not), potentially due to confounding factors such as age, sex, body mass index [BMI], or clinical presentations. We conducted a systematic review with an individual participant data (IPD) meta-analysis to investigate whether trunk postural control differs between those with and without LBP, and whether the difference between groups is impacted by vision and potential confounding factors., Methods: We completed this review according to PRISMA-IPD guidelines. The literature was screened (up to 7th September 2023) from five electronic databases: MEDLINE, CINAHL, Embase, Scopus, and Web of Science Core Collection. Outcome measures were extracted that describe unstable seat movements, specifically centre of pressure or seat angle. Our main analyses included: 1) a two-stage IPD meta-analysis to assess the difference between groups and their interaction with age, sex, BMI, and vision on trunk postural control; 2) and a two-stage IPD meta-regression to determine the effects of LBP clinical features (pain intensity, disability, pain catastrophizing, and fear-avoidance beliefs) on trunk postural control., Results: Forty studies (1,821 participants) were included for the descriptive analysis and 24 studies (1,050 participants) were included for the IPD analysis. IPD meta-analyses revealed three main findings: (a) trunk postural control was worse (higher root mean square displacement [RMSdispl], range, and long-term diffusion; lower mean power frequency) among individuals with than without LBP; (b) trunk postural control deteriorated more (higher RMSdispl, short- and long-term diffusion) among individuals with than without LBP when vision was removed; and (c) older age and higher BMI had greater adverse impacts on trunk postural control (higher short-term diffusion; longer time and distance coordinates of the critical point) among individuals with than without LBP. IPD meta-regressions indicated no associations between the limited LBP clinical features that could be considered and trunk postural control., Conclusion: Trunk postural control appears to be inferior among individuals with LBP, which was indicated by increased seat movements and some evidence of trunk stiffening. These findings are likely explained by delayed or less accurate corrective responses., Systematic Review Registration: This review has been registered in PROSPERO (registration number: CRD42021124658)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: The COVID-19 vaccine has been available and well acceptable among the Saudi population since its introduction in 2020; however, concerns still remain regarding the confidence of doctors in giving such vaccines., Research Question: How confident are physicians in the Kingdom of Saudi Arabia about giving counseling and advice for patients regarding COVID-19 disease and COVID-19 vaccines?, Objective:  To determine how confident Saudi Arabian doctors are in their ability to advise patients on the COVID-19 illness and COVID-19 vaccines., Aim: To assist the health authorities in the Kingdom of Saudi Arabia in developing and implementing programs to improve doctors' skills and knowledge in giving advice to patients about the COVID-19 vaccine., Method: The research employed an online cross-sectional study methodology to gather insights from doctors employed at hospitals, healthcare centers, and clinics across the Kingdom of Saudi Arabia. The inclusion criteria encompassed doctors actively engaged in healthcare settings, while the exclusion criteria were applied to those who had never encountered COVID-19 patients and those who declined participation in the study., Results: It was found that doctors were confident that there's a potential for adverse effects that are not yet seen in vaccine trials. Further results showed that primary health care doctors are more confident about the common side effects associated with the approved vaccines., Conclusion: Most doctors were confident about the vaccine, yet they also know that there are some hidden side effects that are not yet discovered. Since patients trusted doctors as the main source of information about the vaccine, the study provided evidence to emphasize the rule of doctors as a reliable source of information., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alerwi et al.)

Background: During early 2020, because of the COVID-19 pandemic and related lockdown, most education systems-including universities-shifted from face-to-face classes to online learning. In Saudi Arabia, this might have contributed to a decreased level of physical activity (PA) and a concurrent increase in sedentary behaviour among young adults. This study aimed to investigate the impact of online learning on PA during the COVID-19 lockdown period among female undergraduate students in Saudi Arabia., Methods: Data were collected through an online survey administered to participants. It consisted of three sections including demographic information, participants' perception towards online learning and PA, and PA level using the self-reported active-questionnaire survey tool. The association between online learning and PA was measured using linear regression. The statistical significance was set at P  < 0.05., Results: A total of 197 female undergraduate students were included; 95.4% of them were aged 18-24 years old, and 59.9% were in the normal body mass index range (18.5-24.9 kg/m 2 ). In terms of PA level, 55.3% were highly active, 33.5% were moderately active and 10.1% were low-active. In terms of students' perception of engaging in PA, 53.3% of students reported that engaging in PA definitely affected their psychological status. Moreover, compared with those attending <25 hours/week of online learning, those who attended >30 hours/week had lower PA ( r  =  - 363.24; 95% confidence interval (CI) -593.97, -132.50), followed by those attending 25-30 hours/week ( r  =  - 277.66; 95% CI -484.65, -70.66)., Conclusion: Online learning has negatively affected the PA level of female undergraduate students in Saudi Arabia during the COVID-19 lockdown period, in a dose-dependent manner. Moreover, this might affect their phycological status. Nevertheless, future studies are warranted to further investigate the relationship between PA level and psychological status., Competing Interests: The authors declare there are no competing interests., (©2024 Almeheyawi et al.)

Objectives: Double J (DJ) stent is widely used in cases of ureteric strictures as a temporary solution; however, it has certain limitations, such as the need for frequent exchange. Alternatively, a long-lasting thermoexpandable stent (Memokath™ 051) has been used to relieve ureteral obstructions in comorbid patients with multiple reported advantages, such as longer durability which avoids the need of frequent exchanges. In addition, it can be used in certain cases of urethral strictures. Our study is the first in the region to report the experience and outcome of Memokath stent with ureteral and urethral strictures., Materials and Methods: After local IRB approval, we retrospectively reviewed records of 21 patients who underwent insertion of Memokath 051 stent in the ureter and Memokath 045 in the urethra between 2013 and 2021. Indications of insertion, indwelling duration, and causes of removal were collected and analyzed by SPSS., Results: Twenty-one patients received 21 Memokath stents for 11 ureteral strictures and 10 urethral strictures. Fifty-five percent of ureteral strictures were malignant, and 27.3% of the benign ureteric strictures were transplant ureters. Ureteric memokath stents remained functioning for a mean of 16.1 months. Mean indwelling time for transplant ureteric memokath stents was 24.3 months. Total 4 ureteric stents had migrated, 4 stents blocked, and 2 stents were removed as planned and 1 stent removed due to febrile urinary tract infection (UTI). Ten urethral stents remained in place for mean of 14 months. Three stents were removed as planned with resolution of stricture, two were removed due to blockage, three stents had UTI, one was removed due to pain, and one stent remained functioning until the patient expired., Conclusion: Our outcome is comparable to other published studies, suggesting that ureteric Memokath stent is a better option with adequate indwelling time, especially in transplant ureters, in comparison with DJ stents. In addition, Memokath stents can be used in selected recurrent urethral strictures where surgical reconstruction is not feasible., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Urology Annals.)

Background: Physiotherapists must identify potential red flags that may impede recovery and function in individuals with low back pain (LBP) or put them at risk., Objectives: This study aimed to (1) investigate physiotherapists' awareness and use of red flags for individuals with LBP in Saudi Arabia and (2) identify factors associated with their awareness and use of LBP red flags., Methods: This cross-sectional study collected data using an anonymous online questionnaire (February-July 2023). It included physiotherapists working in private/public hospitals in Saudi Arabia. The questionnaire asked about the participants' characteristics, their awareness of LBP red flags, and their use of red flags for LBP assessment., Results: A total of 643 participating physiotherapists (26.2 ± 3.8 years), 63.8% of whom were females, completed the survey. Most participants (94.4%) had adequate awareness of LBP red flags, and more than half (61%) had good utilization of red flags when assessing individuals with LBP. There was a positive correlation between the physiotherapists' awareness and use of LBP red flags., Conclusion: The majority of the participating physiotherapists in Saudi Arabia were aware of LBP red flags, and many reported to have good use of red flags in clinical practice when assessing and managing individuals with LBP.

Purpose: This study aims to investigate the opportunities and challenges of adopting ChatGPT in medical research., Methods: A qualitative approach with focus groups is adopted in this study. A total of 62 participants including academic researchers from different streams in medicine and eHealth, participated in this study., Results: A total of five themes with 16 sub-themes related to the opportunities; and a total of five themes with 12 sub-themes related to the challenges were identified. The major opportunities include improved data collection and analysis, improved communication and accessibility, and support for researchers in multiple streams of medical research. The major challenges identified were limitations of training data leading to bias, ethical issues, technical limitations, and limitations in data collection and analysis., Conclusion: Although ChatGPT can be used as a potential tool in medical research, there is a need for further evidence to generalize its impact on the different research activities., 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 © 2023 Alsadhan, Al-Anezi, Almohanna, Alnaim, Alzahrani, Shinawi, AboAlsamh, Bakhshwain, Alenazy, Arif, Alyousef, Alhamidi, Alghamdi, AlShrayfi, Rubaian, Alanzi, AlSahli, Alturki and Herzallah.)

Background: While the link between obesity and chronic diseases such as diabetes and cardiovascular disorders is well-documented, there is a growing body of evidence connecting obesity with an increased risk of cancer. However, public awareness of this connection remains limited., Study Purpose: To analyze public awareness of overweight/obesity as a risk factor for cancer and analyze public perceptions on the feasibility of ChatGPT, an artificial intelligence-based conversational agent, as an educational intervention tool., Methods: A mixed-methods approach including deductive quantitative cross-sectional approach to draw precise conclusions based on empirical evidence on public awareness of the link between obesity and cancer; and inductive qualitative approach to interpret public perceptions on using ChatGPT for creating awareness of obesity, cancer and its risk factors was used in this study. Participants included adult residents in Saudi Arabia. A total of 486 individuals and 21 individuals were included in the survey and semi-structured interviews respectively., Results: About 65% of the participants are not completely aware of cancer and its risk factors. Significant differences in awareness were observed concerning age groups (p < .0001), socio-economic status (p = .041), and regional distribution (p = .0351). A total of 10 themes were analyzed from the interview data, which included four positive factors (accessibility, personalization, cost-effectiveness, anonymity and privacy, multi-language support) and five negative factors (information inaccuracy, lack of emotional intelligence, dependency and overreliance, data privacy and security, and inability to provide physical support or diagnosis)., Conclusion: This study has underscored the potential of leveraging ChatGPT as a valuable public awareness tool for cancer in Saudi Arabia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alanzi et al.)

Background: Wearable insulin biosensors represent a novel approach that combines the benefits of real-time glucose monitoring and automated insulin delivery, potentially revolutionizing how individuals with diabetes manage their condition., Study Purpose: To analyze the behavioral intentions of wearable insulin biosensors among diabetes patients, the factors that drive or hinder their usage, and the implications for diabetes management and healthcare outcomes., Methods: A cross-sectional survey design was adopted in this study. The validated questionnaire included 10 factors (Performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, trust, perceived privacy risk, and personal innovativeness) affecting the acceptance of wearable insulin sensors. A total of 248 diabetic patients who had used wearable sensors participated in the study., Results: Performance expectancy was rated the highest (Mean = 3.84 out of 5), followed by effort expectancy (Mean = 3.78 out of 5), and trust (Mean = 3.53 out of 5). Statistically significant differences (p < 0.05) were observed with respect to socio-demographic variables including age and gender on various influencing factors and adoption intentions. PE, EE, and trust were positively associated with adoption intentions., Conclusion: While wearable insulin sensors are positively perceived with respect to diabetes management, issues like privacy and security may affect their adoption., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alanzi et al.)

Background: Human iPSCs' derivation and use in clinical studies are transforming medicine. Yet, there is a high cost and long waiting time associated with autologous iPS-based cellular therapy, and the genetic engineering of hypo-immunogenic iPS cell lines is hampered with numerous hurdles. Therefore, it is increasingly interesting to create cell stocks based on HLA haplotype distribution in a given population. This study aimed to assess the potential of HLA-based iPS banking for the Saudi population., Methods: In this study, we interrogated the HLA database of the Saudi Stem Cell Donor Registry (SSCDR), containing high-resolution HLA genotype data from 64,315 registered Saudi donors at the time of analysis. This database was considered to be a representative sample of the Saudi population. The most frequent HLA haplotypes in the Saudi population were determined, and an in-house developed iterative algorithm was used to identify their HLA matching percentages in the SSCDR database and cumulative coverage. Subsequently, to develop a clinically relevant protocol for iPSCs generation, and to illustrate the applicability of the concept of HLA-based banking for cell therapy purposes, the first HLA-based iPS cell line in Saudi Arabia was generated. Clinically relevant methods were employed to generate the two iPS clones from a homozygous donor for the most prevalent HLA haplotype in the Saudi population. The generated lines were then assessed for pluripotency markers, and their ability to differentiate into all three germ layers, beating cardiomyocytes, and neural progenitors was examined. Additionally, the genetic stability of the HLA-iPS cell lines was verified by comparing the mutational burden in the clones and the original blood sample, using whole-genome sequencing. The standards set by the American College of Medical Genetics and Genomics (ACMG) were used to determine the clinical significance of identified variants., Results: The analysis revealed that the establishment of only 13 iPSC lines would match 30% of the Saudi population, 39 lines would attain 50% coverage, and 596 lines would be necessary for over 90% coverage. The proof-of-concept HLA-iPSCs, which cover 6.1% of the Saudi population, successfully demonstrated pluripotency and the ability to differentiate into various cell types including beating cardiomyocytes and neuronal progenitors. The comprehensive genetic analysis corroborated that all identified variants in the derived iPSCs were inherently present in the original donor sample and were classified as benign according to the standards set by the ACMG., Conclusions: Our study sets a road map for introducing iPS-based cell therapy in the Kingdom of Saudi Arabia. It underscores the pragmatic approach of HLA-based iPSC banking which circumvents the limitations of autologous iPS-based cellular therapies. The successful generation and validation of iPSC lines based on the most prevalent HLA haplotype in the Saudi population signify a promising step toward broadening the accessibility and applicability of stem cell therapies and regenerative medicine in Saudi Arabia., (© 2023. The Author(s).)

Context: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia., Design: Online cross-sectional survey-based study., Methods: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS., Results: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery., Conclusions: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements.

Background Aims: Graft failure after allogeneic transplant for aplastic anemia is problematic. The risk of graft failure depends on multiple variables, including the preparative regimen, donor type, stem cell dose and source among other variables., Methods: We performed a retrospective analysis of patients with aplastic anemia who underwent matched-sibling allogeneic transplant at a single center., Results: We identified 82 patients who fit the inclusion criteria. One had primary graft failure and was excluded from this analysis. The recipient median age was 22 years. The donor median age was 23 years. The median time from diagnosis to transplant was 1.6 months. The median number of red cell transfusions before transplant was nine. The median number of platelet transfusions before transplant was 18. Thirteen patients developed secondary graft failure, with a cumulative incidence at 5 years of 16% and median time to develop secondary graft failure of 129 days. All patients engrafted with a median time for neutrophil engraftment of 19 days and a median time for platelet engraftment of 22 days. The survival of patients with or without secondary graft failure was not different. Major or bidirectional ABO incompatibility and older recipient age were statistically significantly associated with greater risk of secondary graft failure., Conclusions: Secondary graft failure is a significant complication after allogeneic transplant for SAA. Identification of recipients at risk and mitigating the potential risks of this complication is warranted., Competing Interests: Declaration of Competing Interest The authors have no commercial, proprietary or financial interest in the products or companies described in this article., (Copyright © 2023 International Society for Cell & Gene Therapy. Published by Elsevier Inc. All rights reserved.)