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We performed the next-generation sequencing (NGS) analysis of a rare grade 1 brain meningioma (angiomatous type) and a common grade 1 spinal meningioma (psammomatous type) and compared their mutation profiling. The data were analysed using the Ion Reporter 5.16 programme (Thermo Fisher Scientific, Waltham, MA). Sequencing analysis identified 10 novel variants and two previously reported variants that were common between these two tumours. Nine variants were missense, which included an insertion in EGFR c.1819_1820insCA, causing frameshifting, and a single nucleotide deletion in HRAS and HNF1A genes, causing frameshifting in these genes. These were common variants identified for both tumours. Also, 10 synonymous variants and 10 intronic variants were common between these two tumours. In intronic variants, two were splice site_5' variants (acceptor site variants). Typical of the angiomatous type tumour, there were 11 novel and six previously reported variants that were not found in the psammomatous tumour; three variants were synonymous, 11 were missense mutations, and three were deletions causing frameshifting. The deletion variants were in the SMARCB1, CDH1, and KDR genes. In contrast, eight novel and five previously reported variants were found in the psammomatous meningioma tumour. In this tumour, two variants were synonymous: a deletion causing a frameshifting in [(c.3920delT; p. (Ile1307fs)], and a two-base pair insertion and deletion (INDEL) [(c.3986_3987delACinsGT; p. (His1329Arg)] both in the APC gene were also found. Among our findings, we have identified that ALK, VHL, CTNNB1, EGFR, ERBB4, PDGFRA, KDR, SMO, ABL1, HRAS, ATM, HNF1A, FLT3, and RB1 mutations are common for psammomatous meningioma and angiomatous tumours. Variants typical for angiomatous (brain) meningioma are PIK3CA, KIT, PTPN11, CDH1, SMAD4, and SMARCB1; the variants typical for psammomatous meningioma are APC, FGFR2, HNF1A, STK11, and JAK3. The RET splice variant (c.1880-2A>C) found in both meningioma tumours is reported (rs193922699) as likely pathogenic in the Single Nucleotide Polymorphism Database (dbSNP). All missense variants detected in these two meningiomas are found in the cancer-driver genes. The eight variants we found in genes such as EGFR, PDGFRA, SMO, FLT3, PIK3CA, PTPN11, CDH1, and RB1 are glioma-driver genes. We did not find any mutations in genes such as BRAF, IDH1, CDKN2A, PTEN, and TP53, which are also listed as cancer-driver genes in gliomas. Mutation profiling utilising NGS technology in meningiomas could help in the accurate diagnosis and classification of these tumours and also in developing more effective treatments., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Taher et al.)

Myelodysplastic syndrome (MDS) describes a group of bone marrow malignancies with variable morphologies and heterogeneous clinical features. The aim of this study was to systematically appraise the published clinical, laboratory, and pathologic characteristics and identify distinct clinical features of MDS in the Middle East and North Africa (MENA) region. We conducted a comprehensive search of the PubMed, Web of Science, EMBASE, and Cochrane Library databases from 2000 to 2021 to identify population-based studies of MDS epidemiology in MENA countries. Of 1935 studies, 13 independent studies published between 2000 and 2021 representing 1306 patients with MDS in the MENA region were included. There was a median of 85 (range 20 to 243) patients per study. Seven studies were performed in Asian MENA countries (732 patients, 56%) and six in North African MENA countries (574 patients, 44%). The pooled mean age was 58.4 years (SD 13.14; 12 studies), and the male-to-female ratio was 1.4. The distribution of WHO MDS subtypes was significantly different between MENA, Western, and Far East populations ( n = 978 patients, p < 0.001). More patients from MENA countries were at high/very high IPSS risk than in Western and Far East populations (730 patients, p < 0.001). There were 562 patients (62.2%) with normal karyotypes and 341 (37.8%) with abnormal karyotypes. Our findings establish that MDS is prevalent within the MENA region and is more severe than in Western populations. MDS appears to be more severe with an unfavorable prognosis in the Asian MENA population than the North African MENA population.

The contribution of anti-inflammatory cytokines to rheumatoid arthritis (RA) is not fully comprehended. In the current research we assessed the serum concentration of interleukin (IL)-37 anti-inflammatory cytokine in RA, studied its association to disease activity score 28 (DAS28) and investigated single nucleotide polymorphism (rs2723176) of IL-37 gene as a threat for RA development. The case-control study included 60 RA patients and 30 normal control individuals. Serum IL-37 was assessed by ELISA and genotyped by "sequence-specific primer-polymerase chain reaction (SSP-PCR)". The mean IL-37 was elevated in RA patients (69.42 ng /l ± 62.99) compared to control individuals (14.66 ng /l ± 23.58, p < 0.001). IL-37 tended to increase with age where highest levels were noted in patients more than 60 years (p = 0.037). No Gender influence was found on IL-37 level (p>0.05). At best cut-off value of 31.5 ng/ l, IL-37 had a sensitivity of 73.3% and specificity of 83.3%. No correlation of IL-37 with DAS 28 score was observed (r=0.1497, p=0.2535). For IL-37 (rs2723176) gene polymorphism, C/C genotype was prevailing in both RA (90%) and normal controls (93.3%) compared to A/C or A/A. Also, no variation was found between patents and controls in regard to C/C genotype (OR = 0.643, 95% CI (0.122-3.39, p=0.603). The mean IL-37 concentration in RA patients with C/C genotype (59.70± 67.92) was not different from AC genotype (80.54± 94.18, p=0.4748). We concluded that serum IL-37 had the implication as a diagnostic marker in RA. However, it did not correlate with clinical severity of the disease. Meanwhile, IL-37 (rs2723176) gene polymorphism did not seem to be as a risk factor for RA, nor contributed to the increase of IL-37 level among patients., (Copyright© by the Egyptian Association of Immunologists.)

Background Overuse or misuse of broad-spectrum antibiotics appeared to be a major cause of increased antibiotic resistance. This study aimed to explore awareness and knowledge of antibiotic prescribing and resistance among hospital physicians in Medina, Saudi Arabia. Methodology A cross-sectional study was conducted among 223 physicians in seven public hospitals in Medina, Saudi Arabia. A validated self-administered questionnaire was used, including questions on sociodemographics, awareness about the current scope of antibiotic resistance, knowledge and frequency of antibiotic prescribing, confidence and input seeking, factors influencing antibiotic prescribing, and attitude toward antibiotic use. t-Test and analysis of variance (ANOVA) tests were used to compare total knowledge scores across the sociodemographic variables. The level of significance was set at 0.05. Results Most participants were aware that antibiotic resistance is a problem in Saudi Arabia (87.4%) and worldwide (93.3%). The majority of physicians (77.6%) were classified as having moderate knowledge, the mean knowledge score on antibiotics was 4.41, and 26.5% of the respondents prescribed antibiotics more than once daily. Most physicians (91.4%) were confident in antibiotic prescribing, and 94.1% of them consulted (at least sometimes ) colleagues before prescribing. Factors associated with knowledge were age ( P  = 0.001), educational level ( P  = 0.002), working years ( P  = 0.004), current position ( P  = 0.003), specialty ( P  = 0.023), duration since graduation from medical school ( P  = 0.002), and duration since the last qualification ( P  = 0.022). Conclusions The majority of physicians had a moderate knowledge level of antibiotics, and most of them were prescribing antibiotics more than two times per week. Most respondents agreed that antimicrobial resistance is a worldwide concern and that it is a problem in Saudi Arabia. This study recommends training and courses on the fact that appropriate antibiotic prescribing should be ensured to have the best practice in antibiotic prescription among physicians., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Al Harbi et al.)

A 55-year-old male patient with a known medical history of diabetes mellitus type 2 and treated lymphoma was first admitted with a sudden left-sided facial asymmetry and mouth deviation to the left side with no other neurological symptoms. A Computerized Tomography (CT) scan of the brain showed acute infarct and small left basal ganglia old lacunar infarction. He was discharged on a dual antiplatelet. One week later, the patient's condition had worsened and, therefore, was admitted with an impression of ischemic stroke. A bedside swallowing assessment, VFSS, and FEES study were conducted to diagnose this case. The bedside assessment did not reveal any sensory or motor deficits in his oral cavity and the FEES examination was also unable to rule out pharyngeal dysphagia. However, a videofluoroscopic swallowing study (VFSS) revealed a significant dysfunction of oral preparation and oral phases and presented difficulty initiating the pharyngeal phase. Given these features, we believe that this swallowing difficulty is caused by swallowing apraxia. This case provides additional information and understanding on management from the swallowing side.

Multiple sclerosis (MS) most commonly presents in young adults, although 3-5% of patients develop MS prior to the age of 18 years. The new and comprehensive consensus for the management of MS in Saudi Arabia includes recommendations for the management of MS and other CNS inflammatory demyelinating disorders in pediatric and adolescent patients. This article summarizes the key recommendations for the diagnosis and management of these disorders in young patients. Pediatric and adult populations with MS differ in their presentation and clinical course. Careful differential diagnosis is important to exclude alternative diagnoses such as acute disseminated encephalomyelitis (ADEM) or neuromyelitis optica spectrum disorders (NMOSD). The diagnosis of MS in a pediatric/adolescent patient is based on the 2017 McDonald diagnostic criteria, as in adults, once the possibility of ADEM or NMOSD has been ruled out. Few data are available from randomized trials to support the use of a specific disease-modifying therapy (DMT) in this population. Interferons and glatiramer acetate are preferred initial choices for DMTs based on observational evidence, with the requirement of a switch to a more effective DMT if breakthrough MS activity occurs., Competing Interests: Declaration of Competing Interest Authors deny any conflict of interest., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: To evaluate the impact of COVID-19 on cancer management in Saudi Arabia's military hospitals., Methods: This multi-centric, retrospective study compared cancer patients diagnosed from February-July 2019 and 2020, focusing on the time duration for acceptance and time for oncologic treatment initiation. Eligibility and referral status were recorded. Clinical data of COVID-19-positive cancer patients were collected and evaluated their outcomes and survival., Results: Data of 1574 cancer patients (mean age, 57.1 years) were collected. Mean time for acceptance was 7.3 days in 2019 and 8 days in 2020, with no statistically significant difference. Mean time for oncology treatment initiation was 38.4 days in 2019 and 44.3 days in 2020, with no statistically significant difference. The number of new cancer patients decreased in 2020 but increased in peripheral hospitals. It decreased in Riyadh and Jeddah hospitals. Concerning referral status, a statistically significant modification was recorded only in Riyadh and Tabuk hospitals. No significant changes observed in time duration for acceptance of new patients and oncology treatment initiation from 2019-2020. A total of 76 COVID-19-positive cancer patients recorded; 72% were symptomatic, 73.6% recovered, 22.3% died due to COVID-19 complications, and 8% died due to cancer; cancer progressed in 7 patients., Conclusion: COVID-19 did not affect oncology service in Saudi Arabia's military hospitals. New cancer cases reduced during the pandemic. Cancer patients are at increased risk for COVID-19 complications, including death., (Copyright: © Saudi Medical Journal.)

Background: Health care is a basic human right, and Saudi Arabia affirms these rights for all its citizens., Objectives: To assess the knowledge of medical students regarding health rights in Saudi Arabia., Methods: This cross-sectional study was conducted at King Abdulaziz University (KAU) from September 2015 through November 2015. A questionnaire written in English collected demographic data and included questions about reproductive health care and health rights of women and patients with cancer, senility, or special needs., Results: Of the 267 participants, 184 (68.9%) were female, and 252 (94.4%) were Saudi. Regarding consent, 87 (32.6%) and 113 (42.3%) participants believed a female patient required the consent of a male guardian to receive medical treatment or surgery, respectively, in Saudi Arabia, and only 106 (39.7%) knew that a female patient could provide consent for a caesarean section. Sixty-six (24.7%) believed that abortion is never allowed in Islam. Only 93 (34.8%) were aware that acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) patients had health rights, about half (144, 53.9%) knew that cancer patients have a right to full information, and most (181, 67.8%) believed that a patient had the right to withhold health information from his/her family. Approximately half were aware that cancer patients have the right to free medical treatment (138, 51.7%) or that health rights applied to special needs patients (137, 51.3%) and senile patients (122, 45.7%)., Conclusions: The knowledge of KAU medical students regarding health rights of certain patient populations highlights the importance of health rights education in medical school.

A facile, reliable, reproducible and ultra-high sensitive aqueous ammonia chemical sensor has been fabricated based on the utilization of La(0.7)Sr(0.3)MnO3 nanoparticles (LSMO NPs), as efficient electron mediators, and reported in this paper. The LSMO NPs were prepared by hydrothermal protocol followed by the annealing process and characterized in detail in terms of their mophological, structural and compositional properties. The I-V technique based aqueous ammonia sensor exhibits an ultra-high sensitivity of 494.68 +/- 0.01 microA cm(-2)mM(-1) and very low-detection limit of 0.2 microM with a response time less than 10 s. To the best of our knowledge, this is the first report in which LSMO is used as an efficient electron mediator for the fabrication of aqueous ammonia chemical sensor. Moreover, by comparing the literature, it is confirmed that the fabricated sensor exhibits highest sensitivity towards the detection of aqueous ammonia. This LSMO nanomaterial based research broadens the range of efficient electron mediators utilized for the fabrication of ultra-high sensitive chemical sensors.

Purpose: This study investigated the effect of eugenol-containing temporary cement on the bond strength of two resin composite core materials (FluoroCore and Ti-Core) to dentin., Materials and Methods: Dentin was exposed in three groups of extracted teeth (20 specimens each). In group one, dentin was covered with eugenol-containing temporary cement; the second group was covered with eugenol-free temporary cement; and the third group was left uncovered and served as a control group. All specimens were stored for 1 week at 37 degrees C and 100% humidity. The dentin surfaces were cleaned and treated using the GLUMA adhesive system, followed by placement of composite core build-ups. Debonding of the core material was accomplished using the Accuforce Elite test system., Results: There was a significant reduction in bond strength for the specimens covered with eugenol temporary cement (p < .0001), but no significant difference was found between the control group and the group treated with eugenol-free temporary cement. Bond strength of the Ti-Core material to dentin was significantly higher than that of FluoroCore (p < .0001)., Conclusion: Pretreatment of the dentin with eugenol-based temporary cement adversely affects the bond strength of resin composite core material to dentin.

The extent of ocular protrusion from the orbit is an important sign in the diagnosis and management of ocular and orbital diseases. Ocular protrusion is dependent, among other factors, on ethnic origin, age, gender, high refractive error, axial length, inter outer orbital distance (IOOD), and interpupillary distance (IPD). The purpose of this study was to provide normal absolute and relative ocular protrusion values for Saudi Arabian male children of Arab origin and to furnish regression equations relating ocular protrusion to age, IOOD, and IPD. A cross-sectional study was designed and ocular protrusion and IOOD were measured using a Hertel prism exophthalmometer. The IPD was measured by using a corneal reflection pupillometer. The data were analyzed using t-test and analysis of variance tests. The average absolute ocular protrusion of the right and left eye was 15.4 mm +/- 1.6 and 15.2 mm +/- 1.6, respectively. The maximum difference in protrusion between the eyes was 2.0 mm. Saudi Arabian male children of Arab origin who have ocular protrusion values outside the 95% confidence intervals should be advised to undergo additional diagnostic tests. A relative ocular protrusion value greater than 2.0 mm may be indicative of unilateral proptosis among these subjects. On the average, Arab children have more ocular protrusion than Caucasians but less than Chinese children.