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Salah H Elsafi,1 Saleh H Almutairi,2 Mujahid A Alsulaimani,3 Salma AlBahrani,4 Thekra N Al-Maqati,1 Wafa K Alanazi,2 Mohammed N Alanazi,2 Abdullah A Alamri,2 Majed Hamoud Alkhathami,5 Rakkad A Alshammari,5 Naif F Alharbi,5 Yaser A Al Naam1 1Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia; 2Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia; 3Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia; 4Infectious Disease Unit, Specialty Internal Medicine, King Fahhd Military Medical Complex, Dhahran Saudi Arabia; College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudia Arabia; 5Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia ArabiaCorrespondence: Yaser A Al Naam, Prince Sultan Military College of Health Sciences, P. O Box 33048, Dammam, 31448, Saudia Arabia, Email yaser@psmchs.edu.saBackground: Earlier reports suggested high rates of antibiotic utilization among COVID-19 patients despite the lack of direct evidence of their activity against viral pathogens. Different trends in antibiotic consumption during 2020 compared to 2019 have been reported.Purpose: The objective of this study is to assess the impact of COVID-19 pandemic on antibiotic consumption in the presence of active Antibiotic Stewardship Program.Methods: This study represented a five years assessment of the consumption of the commonly prescribed antibiotics measured as DDDs/100-Bed Days. We analyzed the data by using nonparametric Friedman and Friedman tests to compare the antibiotic consumption before and during the three subsequent waves of COVID-19.Results: Antibiotic consumption through the DDDs/100-BD has shown reduction in the median of antibiotics consumption of most antibiotics during the period of COVID-19 as compared to the pre-COVID-19 period, which was significant for meropenem and ciprofloxacin, except colomycin that slightly increased. Significant reduction in the consumption of imipenem and meropenem during the second and third waves as compared to the pre-COVID period. Throughout the years, significant reductions were observed between 2018 and 2019 (p=< .001), 2018 and 2020 (p=0.008), and 2018 and 2022 (p=0.002).Conclusion: The reduction in antibiotic consumption is attributed to the strong influence if the ASP and the reluctance of people to visit hospitals during the COVID-19 pandemic. Other related COVID-19 precautions such as physical distance, good hand hygiene, facemasks, that resulted in the prevention of secondary bacterial infections have contributed to the reduction in antibiotic utilization during the pandemic.Keywords: antimicrobial stewardship, ASP, COVID-19, defined daily doses, DDD, antibiotic consumption, Saudi Arabia

Yousef E Alsaedi,1 Asim A Almalki,2 Rakan D Alqurashi,2 Rami S Altwairqi,3 Daifallah M Almalki,3 Khalid M Alshehri,3 Abdullah A Alamri,4 Khaled A Alswat5 1Public Health Department, Madinah Health Cluster, Madinah, Saudi Arabia; 2School of Medicine, Taif University, Taif, Saudi Arabia; 3Diabetes and Endocrine Specialist Center, Prince Mansour Military Hospital, Taif, Saudi Arabia; 4Endocrinology Department, Alhada Armed Forces Hospital, Taif, Saudi Arabia; 5Department of Medicine, School of Medicine, Taif University, Taif, Saudi ArabiaCorrespondence: Yousef E Alsaedi, Public Health Department, Madinah Health Cluster, P.O. Box 8592, Madinah, 42391, Saudi Arabia, Tel +966597181795, Email dr.y.alsa3di@gmail.comBackground: Diabetes mellitus type II (T2D) is a chronic condition that requires significant change in the family behavior and is associated with psychosocial conflicts for both patients and their family environment. The aim of this study is to assess burnout among relatives caring for patients with T2D.Methods: This cross-sectional study with random sampling was conducted on 501 caregivers of patients with T2D between April and September 2021 at Prince Mansour armed forces hospital in Taif city, Saudi Arabia. Data collection tool was a modified version of the caregiver stress self-assessment questionnaire. Data analysis was then carried out using t-test and chi-square test (SPSS v20).Results: The mean patient age was 64.4+12.0 years, female predominant with longstanding T2D. Metformin was the most prescribed T2D medication. The caregivers’ mean age was 34.9+12.4 years, male predominant, and around 45% of them report low level of education and income; 63.9% of the caregivers report little to no stress. Compared with caregivers with mild/moderate stress and moderate/severe stress, caregivers with little to no stress were more likely to be younger in age (P < 0.001), male (P = 0.464), single (P = 0.035), patient’s offspring (P = 0.490), caring for T2D patients with younger age (P = 0.058) and shorter T2D duration (P = 0.074), patients who were less likely to use a wheelchair (P = 0.008), patients who were less likely to be prescribed a complex insulin regimen and with better glycemic control parameters (both P > 0.05), and patients with higher HDL level (P = 0.037).Conclusion: There were no correlations between the caregivers’ levels of stress and the T2D patients’ HbA1c levels. There was a significant positive correlation between a caregiver’s stress score and the caregiver’s age. Future studies are needed to assess other caregivers’ parameters and their relation to metabolic control of T2D patients.Keywords: diabetes, burnout, caregiver

Introduction: Therapeutic inertia in type 2 diabetes, defined as a failure to intensify treatment despite poor glycemic control, can arise due to a variety of factors, despite evidence linking improved glycemic control with reductions in diabetes-related complications. The present study aimed to evaluate the health and economic burden of therapeutic inertia in people with type 2 diabetes in Saudi Arabia., Methods: The IQVIA Core Diabetes Model (v.9.0) was used to evaluate outcomes. Baseline cohort characteristics were sourced from Saudi-specific data, with baseline glycated hemoglobin (HbA1c) tested at 8.0%, 9.0%, and 10.0%. Modeled subjects were brought to an HbA1c target of 7.0% immediately or after delays of 1-5 years across time horizons of 3-50 years. Outcomes were discounted annually at 3.0%. Costs were accounted from a societal perspective and expressed in 2023 Saudi Arabian Riyals (SAR)., Results: Immediate glycemic control was associated with improved or equal life expectancy and quality-adjusted life expectancy and cost savings in all scenarios compared with delays in achieving target HbA1c. Combined cost savings ranged from SAR 411 (EUR 102) per person with a baseline HbA1c of 8.0% versus a 1-year delay over a 3-year time horizon, to SAR 21,422 (EUR 5291) per person with a baseline HbA1c of 10.0% versus a 5-year delay over a 50-year time horizon. Discounted life expectancy and quality-adjusted life expectancy were projected to improve by up to 0.4 years and 0.5 quality-adjusted life years (QALYs), respectively, with immediate glycemic control., Conclusion: Therapeutic inertia was associated with a substantial health and economic burden in Saudi Arabia. Interventions and initiatives that can help to reduce therapeutic inertia are likely to improve health outcomes and reduce healthcare expenditure., (© 2024. The Author(s).)

Background: This systematic review and meta-analysis aimed to investigate the current evidence on the efficacy of tympanostomy and adenoidectomy in children with otitis media with effusion in comparison with tympanostomy alone following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement., Materials and Methods: We completed a comprehensive search of PubMed, Web of Science, Scopus and Cochrane Library databases for relevant studies published in the literature with no date restrictions. We collected the results of the databases search and removed duplicated studies by Rayyan QCRI and EndNote Software X8. We used an Excel sheet for screening titles and abstracts, full text and data extraction. For quality assessment, we used Cochrane Handbook of Systematic Reviews of Interventions 5.1.0 using the quality assessment table provided in Part 2 and Chapter 8.5, and quantitative data synthesis was done using Review Manager (RevMan) software version 5.4., Results: The literature search showed 1510 studies, of which five studies were included in data synthesis. The study measured the effect through number of acute otitis media (AOM) episodes, cumulative number of AOM episodes, siblings with Otitis media (OM), hearing level hearing loss scale of the left, and right ears. The pooled effect estimates showed significant difference between tympanostomy with adenoidectomy versus tympanostomy alone in hearing level hearing loss scale of both ears (SMD -0.17, 95% CI [-0.29, -0.05], P-value=0.005). However, the pooled results were not heterogeneous (P < 0.25, I2 = 24%)., Conclusions: Tympanostomy with adenoidectomy improves hearing compared to tympanostomy alone, but both treatments have similar effects on ear infection rates. Further research with larger samples is needed to confirm these findings and assess long-term benefits., (Copyright © 2024 Copyright: © 2024 African Journal of Paediatric Surgery.)

A novel chelating adsorbent based on (3-iminodiacetic acid) propyltriethoxysilane graphene oxide (IAT-GO) has been developed, showing exceptional promise for capturing lead. IAT-GO is made by combining a high-surface-area graphene oxide with a specially designed chelating ligand, which can selectively and efficiently remove lead. The synthesis of IAT-GO involves a two-step progression. In the first step, covalent bonds form between graphene oxide and (3-aminopropyl)-triethoxysilane (AT) through hydrolysis, condensation, and epoxide ring opening reactions. In the second step, nucleophilic substitution reactions occur between the primary amines and chloroacetic acid (CAA). A comprehensive suite of characterization techniques, including XPS, UV-Vis, XRD, Raman, FTIR, TEM, and SEM, provides detailed insights into the IAT-GO adsorbent's chemical composition and physical form, elucidating its intricate structure and morphology. Optimizing the experimental conditions for using the adsorbent material to remove Pb(II) ions from contaminated water revealed a maximum adsorption capacity of 124.0 mg/g at pH 5 and 30 min. The IAT-GO displays high selectivity for Pb(II) in a mixture of six metal ions containing 100 ppm of each one. Moreover, the IAT-GO shows 100% removal of Pb(II) for concentrations lower than 50 ppm. The excellent fit of the experimental data with the Langmuir adsorption isotherm and pseudo-second-order kinetic models (R2 > 99%) indicates that Pb(II) ion uptake onto the IAT-GO surface occurs via the monolayer formation of mercury ions. IAT-GO demonstrates exceptional potential as an innovative adsorbent for lead-contaminated water. Nitric acid (0.4 M) effectively regenerates the material, while its reusability remains impressive even after five cycles (> 97% removal efficiency). Therefore, this study highlights the development of a groundbreaking material, IAT-GO, with exceptional potential for remediating lead-contaminated water. Its high efficiency, selectivity, reusability, and cost-effectiveness make it a promising candidate for real-world applications., (© 2024. The Author(s).)

Background Sickle cell anemia (SCA) results in various complications, necessitating continuous daily care and placing burdens on caregivers. Objectives This study aims to assess the burden on family caregivers of children with SCA and its associated factors. Materials and methods This analytical cross-sectional study was conducted in Madinah City, Saudi Arabia. We included family caregivers of children with SCA who were registered and treated at the Maternity and Child Hospital in King Salman Medical City. Data were collected from all registered files of children who received treatment for SCA. Data from participants was obtained using the validated Arabic version of the Zarit Burden Interview (ZBI). Descriptive statistics, chi-square tests, independent sample t-tests, and multivariate regression analysis were used in the statistical analysis. Results Overall, 124 caregivers participated out of 166 (response rate: 74.7%), among which 83 (66.9%) were fathers, 72 (58.1%) were aged ≥40 years, 96 (77.4%) held Saudi nationality, and 62 (50%) had a monthly income of <5000 SAR. The average daily caregiving hours were 5±4 hours, and 30 (24.2%) of children were diagnosed with associated physical or psychological diseases. The Zarit Burden Interview score indicated that 45 (36.3%) of caregivers reported no burden, whereas 51 (41.1%), 22 (17.7%), and 6 (4.8%) reported mild, moderate, and severe burden, respectively. Factors contributing to the burden included being a mother, low financial resources, non-Saudi nationality, children diagnosed with associated physical or psychological diseases, and caregiving hours. Conclusions The burden on SCA caregivers was higher for caregivers who were mothers, non-Saudis, those with lower income, and children with physical or psychological diseases, as well as more caregiving hours. Enhancing the overall well-being of families affected by the SCA burden involves creating targeted interventions and comprehensive support programs., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. King Salman bin Abdulaziz Medical City lnstitutional Review Board issued approval 23-055. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. 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, Aloufi et al.)

Objectives: The primary goal of this study was to systematically identify all relevant published articles on the use of primary endoscopic balloon dilation for the management of pediatric patients with subglottic stenosis, critically assess the technique's success, and determine which patients are the best candidates for the procedure., Methodology: This was a systematic review and meta-analysis that aimed to investigate the use and success rate of EBD for treating pediatric SGS. An electronic systematic literature search of three major databases, PubMed, EBSCO, and Web of Science&MEDLINE through Clarivate, was conducted to include the eligible articles., Results: A total of 14 unique studies were included in the final analysis, with 473 cases of pediatric SGS. The pooled success rate of EBD in treatment of pediatric SGS was 76% (k = 14 studies, 95% confidence interval [CI] = 0.65-0.86, P < 0.001, Q test for heterogeneity = 0.03, P < .001, I 2  = 91%)., Conclusions: We reported a high success rate of EBD in treating pediatric SGS. The reported complications were uncommon, although they can be serious and life threatening. The intensity of SGS may be related to the likelihood of therapy failure., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Understanding genetics is crucial for medical students, particularly in Saudi Arabia, where genetic disorders are prevalent owing to high rates of consanguineous marriages. This knowledge is essential for the early detection, prevention, and management of genetic disorders, and for incorporating medical genetics and genomics into patient care. This study aimed to assess the current state of genetics knowledge among medical students and interns across Saudi Arabia and to identify knowledge gaps in genetics., Method: A cross-sectional study was conducted between August and September 2023 involving 732 medical students from all regions of Saudi Arabia. The participants completed a validated questionnaire assessing their knowledge of basic genetics, genetic inheritance, genetic testing, and clinical genetics., Result: Over 60% of medical students and interns reported that they considered themselves to have only slight knowledge in all areas of genetics. The results revealed a general lack of medical genetic understanding among students and interns, particularly regarding genetic inheritance and testing. For genetic inheritance, slight knowledge was found in 65.2% of pre-clinical, 60.1% of clinical, and 53.2% of interns, with significant differences between groups (p < 0.001). In genetic testing, 75.4% of pre-clinical, 83.9% of clinical, and 90.6% of interns showed slight knowledge, with significant differences across stages (p = 0.021). This study also found that lectures, genetics laboratories, and problem-solving sessions were the preferred resources for learning genetics., Conclusion: The current study revealed a notable deficiency in the understanding of medical genetics among medical students and interns in Saudi Arabia, particularly regarding genetic inheritance and testing. This is consistent with previous research highlighting the widespread lack of genetics knowledge among medical students. Integrating more comprehensive genetics education, especially during the clinical years, could improve students' preparedness and confidence in managing genetic disorders. These findings highlight the critical need for curriculum development to equip future physicians with the essential skills for managing genetic disorders., (© 2024. The Author(s).)

Background: Cervical cancer is the eighth most prevalent cancer among women nationwide, with 358 new cases reported annually. One of the strategies to prevent it is getting vaccinated against the human papillomavirus (HPV), the leading cause of this cancer., Methods: A survey-based cross-sectional study was conducted in Riyadh, Saudi Arabia, to evaluate the acceptance of the HPV vaccine among parents of daughters and their knowledge of three domains: cervical cancer, HPV, and the HPV vaccine., Results: 390 parents participated in the study, with 88.2% female, 39.74% of the participants aged between 36-62 years old, and 62.56% holding a bachelor's degree or above. Parents were more aware of cervical cancer (78.97%), followed by HPV (50%) and the HPV vaccine (41.28%). Awareness levels about cervical cancer were significantly different among males and females, while awareness of HPV and the HPV vaccine was significantly associated with parents' education levels. For instance, parents with a bachelor's degree or higher (54.9%) demonstrated greater awareness of HPV compared to parents with a high school diploma (41.9%) or a middle school diploma or less (41.5%). The overall participants' knowledge scores in all three domains were poor, with an average below 50%. 60% of parents believed their daughters should receive the HPV vaccine., Conclusion: More than half of the study participants are willing to vaccinate their daughters with the HPV vaccine despite their poor knowledge of the assessed domains. Awareness levels of HPV and the HPV vaccine are associated with education levels. We believe raising awareness among parents is necessary to improve the acceptance level of the HPV vaccine., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Plant extracts and essential oils can be alternative environmentally friendly agents to combat pathogenic microbes and malaria vectors. Myrrh is an aromatic oligum resin that is extracted from the stem of Commiphora spp. It is used in medicine as an insecticide, cytotoxic, and aromatic. The current study assessed the effect of Commiphora myrrha resin extracts on the biological potency of the third larval stage of Aedes aegypti , as well as its antioxidant and cytotoxic properties against two types of tumor cells (HepG-2 and Hela cell lines). It also used GC-MS to determine the chemical composition of the C. myrrha resin extracts. Fifty components from the extracted plant were tentatively identified using the GC-MS method, with curzerene (33.57%) typically listed as the primary ingredient, but other compounds also make up a significant portion of the mixture, including 1-Methoxy-3,4,5,7-tetramethylnaphthalene (15.50%), β-Elemene (5.80%), 2-Methoxyfuranodiene (5.42%), 2-Isopropyl-4,7-Dimethyl-1-Naphthol (4.71%), and germacrene B (4.35%). The resin extracts obtained from C. myrrha exhibited significant efficacy in DPPH antioxidant activity, as evidenced by an IC 50 value of 26.86 mg/L and a radical scavenging activity percentage of 75.06%. The 50% methanol extract derived from C. myrrha resins exhibited heightened potential for anticancer activity. It demonstrated substantial cytotoxicity against HepG-2 and Hela cells, with IC 50 values of 39.73 and 29.41 µg mL -1 , respectively. Notably, the extract showed non-cytotoxic activity against WI-38 normal cells, with an IC 50 value exceeding 100 µg mL -1 . Moreover, the selectivity index for HepG-2 cancer cells (2.52) was lower compared to Hela cancer cells (3.40). Additionally, MeOH resin extracts were more efficient against the different growth stages of the mosquito A. aegypti , with lower LC 50 , LC 90 , and LC 95 values of 251.83, 923.76, and 1293.35 mg/L, respectively. In comparison to untreated groups (1454 eggs/10 females), the average daily number of eggs deposited (424 eggs/L) decreases at higher doses (1000 mg/L). Finally, we advise continued study into the possible use of C. myrrha resins against additional pests that have medical and veterinary value, and novel chemicals from this extract should be isolated and purified for use in medicines.

The suggested study adheres to a particular protocol to ensure that the process is environmentally friendly and sustainable. It is worth mentioning that several tools have been adopted as prospective measures of the method greenness. Fortunately, the established analytical method is identified as white by the white analytical chemistry (WAC) concept, which uses the red/ green/blue color scheme (RGB 12 tool) to combine ecological and functional factors for the first time in studying of the cited drug. Amlodipine (AMD), a cardiovascular treating agent, belongs to the dihydropyridine class of oral calcium channel-blocking agents. This article presents a novel, simple, green, one-pot-processed, fast, and ultrasensitive fluorimetric approach for monitoring and assessment of AMD using molecular-size-dependent fluorescence augmentation of the light scattering-driven signal of eosin, a biological stain at a wavelength of 415 nm. This enhancement was directly proportional to the size of the produced complex. The linearity range was from 30 to 900 ng mL -1 , with corresponding sensitivity limits (detection and quantitation levels) of 9.2 and 28 ng mL -1 , respectively. The planned approach was also successfully used to track AMD content in bulk, dosage forms, and bio-fluids (human plasma and urine). The developed method's eco-friendliness was established by different eco-rating metric tools., (© 2024 John Wiley & Sons Ltd.)

Background The frequency of irritable bowel syndrome (IBS) has increased significantly in the last ten years. Few studies were done in Saudi Arabia to assess the relationship between sleep quality and IBS. This study aims to assess the prevalence of IBS and its association with sleep quality among adolescents and adults in Saudi Arabia. Methods A cross-sectional study was done on 651 participants aged 15-65 years. An online questionnaire was used to collect data, including demographics; the Rome IV criteria (R4DQ) was used in the diagnosis of IBS, the IBS symptoms severity scale (IBS-SSS) assessed IBS symptoms and severity, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Results Based on the Rome IV criteria, 25.7% of the participants had IBS. Among them, 23.3%, 17.9%, 47.3%, and 11.5% had IBS types constipation (C), diarrhea (D), mixed bowel habits (M), and undefined subtype (U), respectively. Mild, moderate, and severe IBS were found among 43.1%, 39.5%, and 17.4% of IBS cases, respectively. About 46% had poor sleep quality, which was significantly higher among those with younger mean age, females, and students. Patients with IBS exhibited a considerably greater prevalence of poor sleep quality, and IBS-C had the highest prevalence. Conclusion A correlation was found between poor sleep quality and the positive status of IBS diagnosis among adolescents and adults. An evaluation of specific sleep disorders among IBS patients is needed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alghamdi et al.)

Monkeypox virus has remained the most virulent poxvirus since the elimination of smallpox approximately 41 years ago, with distribution mostly in Central and West Africa. Monkeypox (Mpox) in humans is a zoonotically transferred disease that results in a smallpox-like disease. It was first diagnosed in 1970 in the Democratic Republic of the Congo (DRC), and the disease has spread over West and Central Africa. The purpose of this review was to give an up-to-date, thorough, and timely overview on the genomic diversity and evolution of a re-emerging infectious disease. The genetic profile of Mpox may also be helpful in targeting new therapeutic options based on genes, mutations, and phylogeny. Mpox has become a major threat to global health security, necessitating a quick response by virologists, veterinarians, public health professionals, doctors, and researchers to create high-efficiency diagnostic tests, vaccinations, antivirals, and other infection control techniques. The emergence of epidemics outside of Africa emphasizes the disease's global significance. Increased monitoring and identification of Mpox cases are critical tools for obtaining a better knowledge of the ever-changing epidemiology of this disease.

Dispersive liquid-liquid microextraction (DLLME) combined with ultra-high performance liquid chromatography-diode array detector (UHPLC-DAD) method has been developed and validated for the determination of parabens in personal care products. In this study, a natural deep eutectic solvent (NADES) composed of menthol and formic acid at a molar ratio of 1 : 2 was prepared and used as an extraction solvent. The influencing variables on the extraction efficiency such as extraction solvent type and volume, composition of NADES, salt addition, vortex and centrifugation time were investigated. The proposed method exhibited good linearity with determination coefficients of ≥0.9992. The relative recoveries for the studied analytes ranged from 82.19 to 102.45%. Limits of detection and limits of quantification were in the range of 0.17-0.33 ng mL -1 and 0.51-0.99 ng mL -1 , respectively. To evaluate the applicability of the developed method, it was successfully applied to determine four parabens in personal care products. Additionally, the eco-friendliness level of the presented method was evaluated using Eco-Scale Assessment, Green Analytical Procedure Index and Analytical GREEnness metric. The developed method is simple, environmentally friendly and cost effective and it could be employed for determination of parabens in personal care products without harming the environment., Competing Interests: 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., (This journal is © The Royal Society of Chemistry.)

The present study aims at examining predictors of high school students' academic achievement from student-level and school-level predictors in the Kingdom of Saudi Arabia, especially in light of policy mandates on educational reform in accordance with Vision 2030. Participants were 528,854 individuals who took on the Standard Achievement Admission Test (SAAT), along with other demographic variables. The mean age of participants was 19.7 years with an SD  = 1.87. There were 234,813 males and 294,041 females. A Multilevel Random Coefficient Modeling (MRCM) model was engaged to identify predictors of academic achievement. Results indicated the positive roles of being a female, having educational parents, being educated in religious schools or large schools, and having small student-to-teacher ratios and the negative roles of student absences, student age, and being educated in new schools. Results are viewed under the lenses of new policy mandates on educational reform in the Kingdom of Saudi Arabia., 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 Sideridis and Alamri.)

Background One of the main goals of Vision 2030 in Saudi Arabia is to increase the participation rate of Saudi females in the workforce. This adjustment may have a big impact on how they use contraception and increase the tendency to space out their children's births appropriately to help them balance their home and work lives. The purpose of this study was to assess the knowledge on, attitude toward, and practice of contraceptive methods among females of reproductive age (15-49 years) in Al-Qunfudah governorate, Saudi Arabia. Methods A cross-sectional study was carried out among a convenient sample of 400 females of reproductive age in Al-Qunfudah governorate, Saudi Arabia. The necessary data were obtained over a period of two months (from November to December 2022) by using a self-administered online survey that was applied on different electronic platforms. Both knowledge and attitude scores were divided into two categories using the median as a cutoff point (e.g., good knowledge and poor knowledge, as well as positive and negative attitude). Many sociodemographic variables, such as age, residence, and education, were independent variables. Logistic regression analysis was done to determine the magnitude of associations between independent and dependent variables, and the odds ratios (OR) were presented with 95% confidence intervals (CI) at a significance level of P = 0.05. Results Good knowledge of the different contraceptive methods was observed among 69.8% of the females, where contraceptive pills and the intrauterine device (IUD) were the most well-known contraceptive methods to them (85.25% and 57.75%, respectively). Family and friends were their main sources of information (38.75%). Almost 85% of the participants showed a positive attitude toward contraceptive use. Contraceptive pills (32.39%) and IUDs (29.95%) were the most commonly used contraceptive methods. The determinants of good knowledge of contraception were being younger in age (P = 0.01, OR = 0.14, 95% CI = 0.03-0.65) and living in an urban area (P = 0.01, OR = 0.24, 95% CI = 0.09-0.68). Females holding middle or high school educational degrees (P = 0.02, OR = 0.17, 95% CI = 0.04-0.75 and P = 0.03, OR = 0.23, 95% CI = 0.06-0.88, respectively) and having a low monthly income (P = 0.04, OR = 0.44, 95% CI = 0.20-0.96) were likely to have positive attitudes toward contraceptive methods. Conclusion This study concludes that females of reproductive age had satisfactory knowledge and a positive attitude toward various contraceptives; however, there is a big gap in their knowledge regarding two important contraceptive procedures (emergency and permanent contraceptives). Oral contraceptive (OC) pills and IUDs were the most utilized methods of contraception among them. Sustained efforts are needed to raise females' awareness about contraception methods, especially emergency contraceptives and permanent ones. This study was done on a convenient sample of females in reproductive age that may limit the generalization of data; using an online survey has its constraints, such as the ignorance of the illiterate females and those who did not possess internet connections in addition to recall bias; therefore, we recommend further research on this topic through an interactive interview among a random sample of females to overcome such pitfalls., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alkalash et al.)

Genetic polymorphism in long noncoding RNA (lncRNA) HOTAIR is linked with the risk and susceptibility of various cancers in humans. The mechanism involved in the development of CRC is not fully understood but single nucleotide polymorphisms (SNPs) can be used to predict its risk and prognosis. In the present case-control study, we investigated the relationship between HOTAIR (rs12826786, rs920778, and rs1899663) polymorphisms and CRC risk in the Saudi population by genotyping using a TaqMan genotyping assay in 144 CRC cases and 144 age- and sex-matched controls. We found a significant ( p < 0.05) association between SNP rs920778 G > A and CRC risk, and a protective role of SNPs rs12826786 (C > T) and rs1899663 (C > A) was noticed. The homozygous mutant "AA" genotype at rs920778 (G > A) showed a significant correlation with the female sex and colon tumor site. The homozygous TT in SNP rs12816786 (C > T) showed a significant protective association in the male and homozygous AA of SNP rs1899663 (C > A) with colon tumor site. These results indicate that HOTAIR can be a powerful biomarker for predicting the risk of colorectal cancer in the Saudi population. The association between HOTAIR gene polymorphisms and the risk of CRC in the Saudi population was reported for the first time here.

Aims: There is a considerable debate on the impact of qat chewing on dental and oral health. Thereby, this study aimed at assessing the dental caries among qat chewers (QC) and non-qat chewers (NQC) who attend outpatient dental clinics, College of Dentistry, Jazan, Saudi Arabia., Materials and Methods: A sample of 100 QC and 100 NQC were recruited amongst those attended dental clinics, college of dentistry, Jazan University during the 2018-2019 academic year. Their dental health was assessed by three pre-calibrated male interns using DMFT index. The Care Index, Restorative Index and Treatment Index were calculated. Comparisons between both subgroups were done using independent t test. Multiple linear regression analyses were further conducted to stand on the independent determinants of the oral health among this population., Results: QC were unintentionally older (36.55 ± 8.74 years) than NQC (32.96 ± 8.49 years; P = 0.004). Fifty-six percent of QC reported brushing their teeth compared to only 35% (P = 0.001). NQC with university and postgraduate educational levels were more than QC. The mean Decayed [5.91 (5.16)] and DMFT [9.15 (5.87)] were higher among QC compared to NQC [3.73 (3.62) and 6.7 (4.58); P = 0.001 and 0.001, respectively]. The other indices were not different between both subgroups. The multiple linear regression revealed that qat chewing and age, individually or together, as independent determinants for the dental decay, missing, DMFT and TI., Conclusion: Qat chewing habit has a detrimental impact on dental health. It is associated with higher dental caries and missing teeth, and a lower treatment index., (© 2023. The Author(s).)

Background: COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using  their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic., Methodology: This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant., Result: All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures., Conclusion: Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes., (© 2023. The Author(s).)

Objective The objective of this article is to evaluate the morphometry and termination of conus medullaris (CM) in the eastern province of Saudi Arabia. Methodology The lumbar spine magnetic resonance imaging (MRI) scans of 179 citizens of Saudi Arabia were selected and divided into males and females. Parameters such as the level of termination of CM, the length/width of CM, and its termination were reported. Results The maximum number of males and females were observed in the less than 20 years age group as 23 (25.5%) and 22 (24.7%), respectively. The termination level of CM was at the (first lumbar vertebra) L1 vertebra in 51.4% of the Saudi population. The level of termination of CM is below the (second lumbar vertebra) L2 level in one patient at L3, L3-L4, L5, and L5-S1 levels. On comparing the length of CM, no statistically significant difference was observed between the different levels of the vertebra. However, there was a statistically significant difference between the width and the CM termination (p=0.02). The various age groups and CM termination had no statistically significant correlation (p=0.47). Conclusion The most common level of termination of conus medullaris was at the L1 vertebra. The level of CM termination is strongly associated with the width of CM., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Hiware et al.)

The COVID-19 pandemic has created huge economic and healthcare burdens. In most cases, the virus affects the lungs and causes respiratory symptoms. Additionally, its impact on the cranial nerves remains unclear. We thus aimed to investigate cranial nerve dysfunction in patients with COVID-19 infection.  We conducted a systematic literature search of relevant and eligible literature in five databases: PubMed, Web of Science, Medline, EBSCO, and Google Scholar.  Our sample included 21 case reports, one case series with 29 patients, and one analytical study with 135 cases. Participant ages ranged from 23 months to 72 years (mean age of 47.5 ± 19.02). The mean time from respiratory symptoms to the onset of neurological signs was (9.6 ± 7.4) days, and the mean recovery time was (16.3 ± 15.3) days.  Cranial nerve impairment associated with COVID-19 infection has affected a large population, from infants to the elderly. Facial and abducent nerves were the most commonly affected cranial nerves with reported good prognosis or complete recovery within a few days to weeks. Olfactory dysfunctions were widely detected among COVID-19 patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Tonkal et al.)

Background Borderline personality disorder (BPD) is a mental illness characterized by emotional instability. Its prevalence can be as high as 1.8% among the general population. Poor knowledge and negative perceptions of the disorder by mental health workers (MHWs) can affect patients' care and their help-seeking behavior. This study aims to explore MHW's knowledge and attitudes toward BPD. Method A cross-sectional study was conducted on MHWs across the five regions of Saudi Arabia (SA) using a questionnaire that assessed knowledge, attitude, and training regarding BPD. Results  Data collected from 1028 MHWs showed a good knowledge level. Superior knowledge was observed among females, residents in the central region, physicians, those who received specific BPD training, and MHWs who had more experience and frequent interactions with BPD patients. Participants had moderate to high levels of perceived knowledge and confidence regarding the identification, assessment, and management of BPD patients. Undergraduate training programs were the most reported source of information on the disorder. While 66% of participants admitted that they find dealing with BPD patients more difficult and thought patient management was inadequate, 71% were willing to attend further BPD training. Conclusion MHWs in SA have moderate knowledge of but negative perceptions of BPD; specific training is needed to improve the care provided for BPD patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Aljohani et al.)

Background Diabetes mellitus is a major public health problem worldwide. Diabetic patients may suffer many complications including diabetic retinopathy, which can lead to blindness if left undiagnosed and untreated. Methodology A cross-sectional analytical study was conducted among a sample of 251 adult diabetic patients in the Al Qunfudah district. A self-administrated questionnaire was used for data collection and consisted of the following three sections: sociodemographic data, diabetes mellitus, and diabetic retinopathy-related data. Results Out of the 251 participants, 68.5% recognized that diabetes mellitus can cause eye disorders, and 72.5% of the participants knew that regular eye examinations are recommended for diabetic patients. Adequate knowledge score was observed among diabetic patients aged 25-49 years (52.6%), with a university education (53.5%), with a history of diabetes for 10 years and more (60.5%), those on insulin therapy (55.3%), those adherent to their regular treatment (92.1%), and those getting their information from doctors (73.7%). Conclusions Diabetic patients had average knowledge about diabetic retinopathy but little awareness regarding the frequency of regular eye examinations and the physicians who should conduct them. Intensive health education concerning diabetic retinopathy should be conducted for diabetic patients and their caregivers to improve their perception and compliance with eye care and prevent visual damage in the Al Qunfudhah district., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alkalash et al.)

Background: Among gram-negative bacteria, Klebsiella pneumoniae is one of the most common causes of healthcare-related infection. Bloodstream infections (BSIs) caused by Klebsiella pneumoniae are notorious for being difficult to treat due to resistance to commonly used antimicrobials. Klebsiella pneumoniae isolates from bloodstream infections are becoming increasingly resistant to carbapenems. In the fight against carbapenem-resistant Klebsiella pneumoniae, colistin [polymyxin E] is the antimicrobial of choice and is thus widely used. Objective: This study aimed to determine the global prevalence of colistin resistance amongst Klebsiella pneumoniae isolates from bloodstream infections. Methods: PubMed, Medline, Scopus, and the Cochrane Library were searched for published articles without restricting the search period. Studies meeting the predefined inclusion and exclusion criteria were included, and quality was assessed using Joanna Briggs Institute Checklist. We used a statistical random effect model to analyze data with substantial heterogeneity (I2 > 50%) in the meta-analysis. Results: A total of 10 studies out of 2873 search results that met the inclusion criteria were included in the final synthesis for this study. A pooled prevalence of colistin resistance was 3.1%, 95% CI (1.5−4.7%). The highest colistin resistance pooled prevalence was recorded in isolates studied in 2020 and beyond 12.90% (4/31), while Klebsiella pneumoniae isolates studied in 2015 and before and in 2016−2019 showed a pooled colistin resistance rate of 2.89% (48/1661) and 2.95% (28/948), respectively. The highest colistin resistance was found in Klebsiella pneumoniae isolates from Thailand (19.2%), while the least pooled resistance was in Klebsiella pneumoniae from South Korea (0.8%). The pooled prevalence of the multidrug-resistant (MDR) of Klebsiella pneumoniae from bloodstream infection ranged from 80.1%, 95% CI (65.0−95.2%), and the resistance prevalence of other antibiotics by Klebsiella pneumoniae from bloodstream infections were as follows; ciprofloxacin (45.3%), ertapenem (44.4%), meropenem (36.1%), imipenem (35.2%), gentamicin (33.3%), amikacin (25.4%) and tigecycline (5.1%). Klebsiella pneumoniae recovered from the intensive care unit (ICU) showed higher colistin resistance, 11.5% (9/781%), while non-ICU patients showed 3.03% (80/2604) pooled colistin resistance. Conclusion: This study showed low colistin resistance in Klebsiella pneumoniae isolates from global bloodstream infections. However, significant colistin resistance was observed in isolates collected from 2020 and beyond. Significant colistin resistance was also observed in Klebsiella pneumoniae isolates in bloodstream infections from the intensive care unit (ICU) compared to those from non-ICUs. As a result, there is a need to institute colistin administration stewardship in the ICU in clinical settings.

When COVID-19 was first announced back in 2019, there were vast number of attempts to halt the progression of the SARS-CoV-2 virus once and for all [...].

Inadequate pain management affects the patient outcome. Pain assessment and management are fundamental in nursing care, and nurses must be equipped with adequate knowledge and a positive attitude toward pain assessment and management. This study aims to evaluate nurses’ knowledge and attitudes regarding pain assessment and management at King Fahad Hospital, Al-Madinah, Kingdom of Saudi Arabia. A quantitative, cross-sectional survey, using a self-administered questionnaire, was conducted from January to February 2020 with 660 registered nurses working in the Emergency Department, critical care units, inpatient and outpatient departments at King Fahad Hospital in Al-Medinah, Kingdom of Saudi Arabia. The data were analyzed with descriptive and inferential statistics. Of the 660 nurses, 291 responded, resulting in a response rate of 44.09%. The participants’ scores ranged from 17.7% to 100%, with a mean score 45.29%. The majority of the participants (70.1%) had a poor level of knowledge and attitudes (score < 50%). Nurses working in the outpatient department scored significantly higher than the group working in the Emergency Department and inpatient wards. Deficient knowledge and negative attitudes were found and nurses continue to underassess and undertreat pain. Nursing school curricula and in-service continuous education must equip nurses with the required knowledge and attitudes to enable them to manage pain effectively.

Introduction: External high-volume extraction (HVE) devices may offer a way to reduce any aerosol particulate generated. The aim of this study was to measure the particle count during dental aerosol-generating procedures and compare the results with when a HVE device is used., Materials and Methods: Design A comparative clinical study measuring the amount of PM1, PM2.5, and PM10 aerosol particulate with and without the use of an external HVE device was undertaken. Materials and methods in total, ten restorative procedures were monitored with an industrial Trotec PC220 particle counter. The intervention was an external HVE device. Main outcome methods the air sampler was placed at the average working distance of the clinicians involved in the study - 420 mm., Results: In the present study, aerosol particulate was recorded at statistically significantly increased levels during dental procedures without an external HVE device versus with the device. Discussion The null hypothesis was rejected, in that significant differences were found between the results of the amount of aerosol particle count with and without a HVE device., Conclusion: If the results of the present study are repeated in an in vivo setting, an external high-volume suction device may potentially show a lower risk of transmission of viral particulate., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Pharmacy and Bioallied Sciences.)

The complement system, a network of highly-regulated proteins, represents a vital part of the innate immune response. Over-activation of the complement system plays an important role in inflammation, tissue damage, and infectious disease severity. The prevalence of MERS-CoV in Saudi Arabia remains significant and cases are still being reported. The role of complement in Middle East Respiratory Syndrome coronavirus (MERS-CoV) pathogenesis and complement-modulating treatment strategies has received limited attention, and studies involving MERS-CoV-infected patients have not been reported. This study offers the first insight into the pulmonary expression profile including seven complement proteins, complement regulatory factors, IL-8, and RANTES in MERS-CoV infected patients without underlying chronic medical conditions. Our results significantly indicate high expression levels of complement anaphylatoxins (C3a and C5a), IL-8, and RANTES in the lungs of MERS-CoV-infected patients. The upregulation of lung complement anaphylatoxins, C5a, and C3a was positively correlated with IL-8, RANTES, and the fatality rate. Our results also showed upregulation of the positive regulatory complement factor P, suggesting positive regulation of the complement during MERS-CoV infection. High levels of lung C5a, C3a, factor P, IL-8, and RANTES may contribute to the immunopathology, disease severity, ARDS development, and a higher fatality rate in MERS-CoV-infected patients. These findings highlight the potential prognostic utility of C5a, C3a, IL-8, and RANTES as biomarkers for MERS-CoV disease severity and mortality. To further explore the prediction of functional partners (proteins) of highly expressed proteins (C5a, C3a, factor P, IL-8, and RANTES), the computational protein-protein interaction (PPI) network was constructed, and six proteins (hub nodes) were identified., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Inflammatory bowel disease (IBD), which can have a considerable effect on quality of life, productivity and performance, is typically diagnosed during periods of life in which patients have academic and career-related responsibilities., Objective: The objective of the study was to determine the effect of IBD symptoms on work and school absenteeism in patients from Saudi Arabia., Patients and Methods: This cross-sectional survey included patients diagnosed with IBD, aged >8-60 years, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The validated 32-question IBD quality-of-life questionnaire was used to elicit information regarding quality of life and another 9-question validated questionnaire was used to assess work and school absenteeism. A logistic regression analysis was used to identify possible determinants of absenteeism., Results: A total of 123 IBD patients were included, with a 1:1 male-to-female ratio. The median age at presentation was 26 years (range: 8-59 years), 56.9% had Crohn's disease, and 43.1% had ulcerative colitis. Further, 58 (47.2%) were employed, 49 (39.8%) were students and 16 (13%) were unemployed. Forty-seven (43.9%) participants reported absenteeism: 26 were employees (55.3%) and 21 were students (44.7%). A binary logistic regression analysis identified IBD subtype ( P = 0.006) and the presence of perianal disease ( P = 0.028) as clinical predictors for absenteeism from school or work. A feeling of abdominal pain ( P = 0.015), fatigue ( P = 0.015) and difficulty taking part in social engagements ( P < 0.001) were also significantly associated with absenteeism., Conclusions: A sizeable proportion of the participants reported absenteeism owing to the effects of IBD. IBD subtype, perianal disease, presence of ongoing abdominal pain, fatigue and difficulty in social engagement were strongly associated with nonattendance., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Saudi Journal of Medicine & Medical Sciences.)

Sialic acid that presents on the surface of lung epithelial cells is considered as one of the main binding targets for many respiratory viruses, including influenza and the current coronavirus (SARS-CoV-2) through the viral surface protein hemagglutinin. Gold nanoparticles (Au NPs) are extensively used in the diagnostic field owing to a phenomenon known as 'surface plasmonic resonance' in which the scattered light is absorbed by these NPs and can be detected via UV-Vis spectrophotometry. Consequently, sialic acid conjugated Au NPs (SA-Au NPs) were utilized for their plasmonic effect against SARS-CoV-2, influenza B virus, and Middle-East respiratory syndrome-related coronavirus (MERS) in patients' swab samples. The SA-Au NPs system was prepared by a one-pot synthesis method, through which the NPs solution color changed from pale yellow to dark red wine color, indicting its successful preparation. In addition, the SA-Au NPs had an average particle size of 30 ± 1 nm, negative zeta potential (-30 ± 0.3 mV), and a UV absorbance of 525 nm. These NPs have proven their ability to change the color of the NPs solutions and patients' swabs that contain SARS-CoV-2, influenza B, and MERS viruses, suggesting a rapid and straightforward detection tool that would reduce the spread of these viral infections and accelerate the therapeutic intervention.

Background: Recent occurrence of the 2019 coronavirus disease (COVID-19) outbreak, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has highlighted the need for fast, accurate, and simple strategies to identify cases on a large scale., Objective: This study aims to develop and test an accurate detection and severity classification methodology that may help medical professionals and non-radiologists recognize the behavior and propagation mechanisms of the virus by viewing computed tomography (CT) images of the lungs with implicit materials., Methods: In this study, the process of detecting the virus began with the deployment of a virtual material inside CT images of the lungs of 128 patients. Virtual material is a hypothetical material that can penetrate the healthy regions in the image by performing sequential numerical measurements to interpret images with high data accuracy. The proposed method also provides a segmented image of only the healthy parts of the lung., Results: The resulting segmented images, which represent healthy parts of the lung, are classified into six levels of severity. These levels are classified according to physical symptoms. The results of the proposed methodology are compared with those of the radiologists' reports. This comparison revealed that the gold-standard reports correlated with the results of the proposed methodology with a high accuracy rate of 93%., Conclusion: The study results indicate the possibility of relying on the proposed methodology for discovering the effects of the SARS-CoV-2 virus in the lungs through CT imaging analysis with limited dependency on radiologists.

Objectives: This study aimed to evaluate knowledge, attitudes, and practices toward added sugar intake and the associations with nutrient intakes and weight status., Methods: This cross-sectional study was conducted among 190 healthy female undergraduate students at Taibah University, Madinah, Saudi Arabia. Demographic, knowledge and attitudes toward added sugar, dietary intake, and anthropometric data (i.e., height, weight, and waist circumference) were collected during face-to-face interviews., Results: Approximately half of the students (n = 106; 55.8%) were aware of the health consequences of excessive intake of added sugar, but only 32.6% (n = 62) reported making an effort to reduce their added sugar intake. The data indicated that 8.42% of the students (n = 16) consumed carbonated soft drinks daily, 15.8% (n = 30) consumed fruit drinks daily, and 45.8% (n = 87) consumed sweets daily. Underweight students consumed higher quantities of added sugar (expressed as percent of total energy intake) compared with students in all other weight status groups. Results showed negative associations between percentage of added sugar intake and intakes of fiber, iron, zinc, vitamin D, body mass index, and waist circumference., Conclusions: Our findings indicated that a large proportion of young women had limited knowledge on the health consequences of excessive added sugar intakes. The observed inverse relationships between added sugar and micronutrient intakes and the weight status highlight the urgent need for expanded efforts to improve added sugar-related knowledge and promote the reduction of added sugar intake among young women., Competing Interests: Declaration of interests 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 © 2020 Elsevier Inc. All rights reserved.)

The main thesis of the present study is to use the Bayesian structural equation modeling (BSEM) methodology of establishing approximate measurement invariance (A-MI) using data from a national examination in Saudi Arabia as an alternative to not meeting strong invariance criteria. Instead, we illustrate how to account for the absence of measurement invariance using relative compared to exact criteria. A secondary goal was to compare latent means across groups using invariant parameters only and through utilizing exact and relative evaluative-MI protocol suggested equivalence of the thresholds using prior variances equal to 0.10. Subsequent differences between groups were evaluated using effect size criteria and the prior-posterior predictive p -value (PPPP), which proved to be invaluable in attesting for differences that are beyond zero, some meaningless nonzero estimate, and the three commonly used indices of effect sizes described by Cohen in 1988 (i.e., .20, .50, and .80). Results substantiated the use of the PPPP for evaluating mean differences across groups when utilizing nonexact evaluative criteria., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2019.)

MERS-CoV, a highly pathogenic virus in humans, is associated with high morbidity and case fatality. Inflammatory responses have a significant impact on MERS-CoV pathogenesis and disease outcome. However, CD4 + T-cell induced immune responses during acute MERS-CoV infection are barely detectable, with potent inhibition of effector T cells and downregulation of antigen presentation. The local pulmonary immune response, particularly the Th1 and Th2-related immune response during acute severe MERS-CoV infection is not fully understood. In this study, we offer the first insights into the pulmonary gene expression profile of Th1 and Th2-related cytokines/chemokines (Th1 & Th2 responses) during acute MERS-CoV infection using RT 2 Profiler PCR Arrays. We also quantified the expression level of primary inflammatory cytokines/chemokines. Our results showed a downregulation of Th2, inadequate (partial) Th1 immune response and high expression levels of inflammatory cytokines IL-1α and IL-1β and the neutrophil chemoattractant chemokine IL-8 (CXCL8) in the lower respiratory tract of MERS-CoV infected patients. Moreover, we identified a high viral load in all included patients. We also observed a correlation between inflammatory cytokines, Th1, and Th2 downregulation and the case fatality rate. Th1 and Th2 response downregulation, high expression of inflammatory cytokines, and high viral load may contribute to lung inflammation, severe infection, the evolution of pneumonia and ARDS, and a higher case fatality rate. Further study of the molecular mechanisms underlying the Th1 and Th2 regulatory pathways will be vital for active vaccine development and the identification of novel therapeutic strategies., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The Saudi government is currently facing multiple challenges in achieving "The Gold Standard" in nursing practice. This is not limited to educational challenges, staffing shortage, paucity of international and national benchmark evidence, absence of clear and defined scope of nursing practice, and lack of appropriate policies and regulations. This study presented a comprehensive plan for developing a policy based on current challenges, recognition of policy goals, assessment of potential options and alternatives, identification of stakeholders, proposition of recommended solutions, and implementation of the framework to transform nursing standards and link these changes with the Saudi Vision 2030. However, amendments are required in the present strategic plan for the better management of the nursing profession. It is doubtful that the current nursing profession status quo is capable of meeting the golden standards for health care. Thus, the transformation of the nursing profession in Saudi Arabia is necessary., Competing Interests: 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., (© 2020 The Author(s).)

Aim: The present study aimed to analyse the disaster preparedness among Saudi nurses through self-regulation survey., Background: Nurses along with other healthcare professionals face difficulty in terms of management during disastrous condition. Moreover, there is a need to improve the abilities of nurses in managing disaster events by examining the disaster preparedness of nurses., Methods: It employed quantitative descriptive design by conducting a self-regulation survey among 350 nurses recruited from five government hospitals in Medina, Saudi Arabia. Data related to the motivation, commitment and self-regulation of nurses concerning their participation in disaster preparedness activities were collected., Results: Self-regulation scores were significantly related to the nationality (t [328] 3.95, p < .001), nursing education (t [328] 2.14, p < .05), age group (F [2,327] 4.75, p < .01) and experience (F [3,317] 4.891, p < .01), whereas insignificant association was found with gender (t [328] 1.84, p > .05) and hospitals (F [4,325] 0.925, p > .05)., Conclusion: The level of knowledge of the healthcare nurses was satisfactory for the disaster preparedness, while there prevails a neutral level of involvement, preparedness and commitment among them., Implications for Nursing Management: There is a crucial need for hospital management to arrange disaster preparedness awareness and understanding programs for nurses and hospital staff to be competent for overcoming the risks associated with these events., (© 2019 John Wiley & Sons Ltd.)

Introduction: Plastic surgery is a medical specialty involving the restoration, reconstruction, or alteration of the body. Knowledge about facial plastic surgery among doctors is limited according to some literatures and enriched according to others, depending on the country and study population., Aim: Aim of the study was to evaluate level of knowledge of health care professionals regarding facial plastic surgery., Material and Methods: A cross-sectional study included total of 261 health care professionals (consultants, specialists and residents in training) at King Abdul-Aziz University Hospital (KAUH) from all subspecialties during July 2018. The data collected using pre-designed questionnaire and analyzed using professional statistics software., Results: Among 261 participants, sex distribution shows a male-female ratio of 2.78:1. The majority (62.8%) of participants were residents. Mean age (± SD) of participants was 32.28 ± 8.43. Pediatrics, internal medicine, and general surgery were the most common specialties. Among participants, 75.5% agreed that taking training in plastic surgery program is a requirement to be a facial plastic surgeon whether it should be accompanied with at least one other surgery training (23%) or more than one other training (22.2%). The majority (97.7%) have never undergone a facial plastic surgery operation and 78.2% were not willing to undergo one., Conclusion: The study concludes that the knowledge and perception among healthcare professionals in KAUH regarding facial plastic surgeries is on relatively good basis but needs more updates and trainings., Competing Interests: Authors declared no conflict of interest., (© 2019 Abdullah A. Alamri, Reham AlJehani, Majed N. Alnefaie, Sabah Moshref, Abdulkareem R. Fida.)

Aim: To find out the factors and causes that motivate medical students to choose ear, nose, and throat (ORL head and neck surgery) as a specialty in Saudi Arabian medical universities., Materials and Methods: A cross-sectional study was conducted at Kingdom of Saudi Arabia by distributing a self-administered questionnaire to 1,516 medical students across all medical universities. Chi-squared test and logistic regression analyses were used to examine the association between the participants' choices and factors motivating their choice of specialty., Results: ORL head and neck surgery was chosen as a future specialty by 27% of the participants. Of these, 52% chose lifestyle as the most influential factor determining their choice of specialty. Further analysis of participant preferences revealed that 87.6% listed flexibility within medicine as their main reason for choosing a specialty, followed by reasonable hours of practice in 86%, while 15.9% considered a strong mentor relationship to be important. Students from King Abdulaziz University more frequently chose ORL head and neck, along with those from the eastern kingdom compared with other areas. Student preference for ORL head and neck did not vary significantly with gender, age, or duration of clinical rounds., Conclusion: Approximately 27% of students chose ORL head and neck, with lifestyle being the most influential factor, followed by flexibility within medicine. Among students who chose ORL head and neck, the highest percentage was from King Abdulaziz University., Competing Interests: There are no conflicts of interest.

Introduction: Respiratory distress syndrome (RDS) is a respiratory disorder of neonates that manifests itself within few hours after delivery. It is one of the most common causes of admission to neonatal intensive care unit (NICU) and respiratory failure in neonates., Aim: The aim of this study was to determine the incidence, risk factors, and the short-term outcomes of RDS in term infants born in an academic tertiary care center at King Abdul-Aziz University Hospital (KAUH), Jeddah, Saudi Arabia., Methods: Data of all infants admitted to the NICU at the academic center between January 1 st 2016 and December 31 st 2016 were retrospectively collected. Cases were all term infants who were admitted to NICU with the diagnosis of RDS during the study period. Controls were term infants and 1:1 matched for the date of birth (one or two days from the date of birth of the case) and received routine newborn care., Results: Fifty-nine term infants (59/3601, 1.64%) were admitted to the NICU with RDS and 59 control infants were matched during the study period. Infants with RDS were significantly of lower birth weight and had lower Apgar scores at one and five minutes. Although there was a higher number of cesarean section and PROM in the RDS group, but that didn't reach statistical significance. Three infants (5.1%) died in the RDS group., Conclusion: Respiratory distress in term infants is still a significant cause of admission to NICU and a predisposing factor for neonatal mortality and morbidity. Preventative and anticipatory measures should be further explored to decrease the burden of this disease.

Background/aim: Obesity has become a global health care problem. In Saudi Arabia, up to 75% of adults are reportedly overweight. Morbid obesity has been associated with an increased risk of many comorbidities and mortality. Bariatric surgery is currently considered the most effective treatment option for morbid obesity. However, there are many concerns regarding the short and long-term complications of weight reduction surgery. It is unclear whether the general population is adequately aware of these risks. Therefore, we aimed to assess awareness of the general population of bariatric surgery complications. Although effective, bariatric surgery has been associated with many acute complications, reported in a range of 0.3% to 8% of operations., Patients and Methods: We performed a cross-sectional study between July and August of 2017 in Jeddah, Saudi Arabia. We used a 26-item, Arabic, electronically distributed questionnaire, to examine public awareness of the acute complications of bariatric surgery. Hypothesis testing was used to examine associations., Results: In total, 624 questionnaires were completed electronically. Mean age of participants was 25 (±13.2) and 66% were females. Of the surveyed population, 64% reported being aware of acute complications of bariatric surgery. Participants who had previously undergone a bariatric operation had a higher degree of awareness when compared to those who had not undergone a bariatric operation before (80.4% vs. 61.3%, P < 0.001). Females had higher awareness compared to males (70.8% vs. 52.1%, P < 0.001). Awareness of complications was not statistically different when stratified by level of education (P = 0.131) but occupation predicted awareness (P = 0.007)., Conclusion: Two-thirds of the general population appears to be aware of the potential acute complications associated with bariatric surgery. Furthermore, awareness seems to be higher in females, individuals who had previously undergone weight reduction surgery, and health care workers., Competing Interests: None

Introduction: Musculoskeletal (MSK) manifestations represent a common work-related physical complication that affect surgeons and impacts their life and the healthcare service negatively., Aim: The aim of this study was to determine the prevalence of work related MSK manifestations among surgeons in a tertiary care hospital and to identify the possible associated risk factors., Methods: A Web-based self-administered cross-sectional survey was conducted. This study targeted all surgeons regardless of their nationalities, ages, genders, and marital statuses. The questionnaire assessed the participants' demographic data as well as musculoskeletal manifestations., Results: Most respondents (80%) suffered from MSK manifestations that were related to performing surgeries. Back and neck areas represented the most affected body parts (71.1% and 59.8%, respectively). A significantly higher percentage of those with musculoskeletal manifestations practiced for 5-10 years (28.9%) (p = 0.006)., Conclusion: MSK pain is common among Saudi surgeons in different specialties. More attention should be directed to improving the physical environments in which the surgeons are operating. Moreover, surgeons should be educated about the recommended ergonomic positions that can prevent or decrease their work related MSK manifestations.

Introduction: Blood transfusion practices affect both patient's outcomes and utilization of institutional resources. Evidence shows that liberal blood transfusion has a detrimental effect on patient's outcome. A restrictive approach of blood transfusion is recommended by current clinical guidelines., Aim: The aim of this study was to evaluate the attitudes, knowledge, and practices of general surgery (GS) staff and residents regarding peri-operative blood transfusion and anemia management., Material and Methods: A self-administered, web-based questionnaire was developed, and its link was sent to the emails of all general surgeons at King Abdul-Aziz University Hospital (KAUH), Jeddah city, Saudi Arabia. The questionnaire included four parts: 1) background of surgeons; 2) preoperative assessment and management of anemia; 3) post-operative blood transfusion and alternatives; and 4) enablers and barriers., Results: 56 surgeons responded to the questionnaire. We found variations in blood transfusion practices, notably the hemoglobin threshold. For stable non-cardiac cases, 7 g/dL was considered the threshold by 50% of respondents. For stable patients with past cardiac disease, a higher threshold was chosen by most (9 g/dL by 43% and 10 gm/dL by 21%). Most respondents believed that transfusion had no effect on the risk of survival (73%) and on the risk of cancer recurrence (55%) after oncologic surgical resection. Recognized facilitators were the availability of scientific evidence (84%), medicolegal concerns (57%), preference (52%), and institutional protocols (50%)., Conclusion: Although current clinical guidelines recommend a restrictive transfusion practice, most respondents tended to over-order blood for elective procedures and were not aware of the potential complications of liberal blood transfusion. To implement the restrictive transfusion policies, health institutions should improve the awareness of surgeons and incorporate a strong supporting evidence in formulating local institutional guidelines.

Objectives: To assess vaccination timeliness, risk factors associated with delays and the reasons for delayed vaccinations among children below the age of 3 years in Jeddah, Kingdom of Saudi Arabia., Methods: This is a cross-sectional study conducted in Jeddah, Saudi Arabia during the period of May 2016 to August 2017. Data were obtained from parents of children under the age of 3 years using a structured questionnaire comprised of questions about sociodemographics, physical well-being of the child and the reasons that are used to justify delayed vaccinations. Vaccinations were considered delayed if they occurred more than 30 days after the time designated on the primary vaccination schedule. Logistic regression was used to assess the risk factors for vaccination delays., Results: The study included 351 children. Delayed vaccinations were observed in 85/351 (24.2%) of the sample. Delays were noted to occur most frequently for Measles, Mumps, Rubella vaccine (MMR), seconddose of meningococcal conjugate quadrivalent vaccine (MCV4), second  dose of oral polio vaccine (OPV) and fourth  dose of pneumococcal conjugate vaccine (PCV) in 19/125 (15.2%) of the sample. Traveling at the time of vaccination was the most common delay reason and was reported in 31/142 (21.3%) of the sample., Conclusion: Adherence to vaccination is fairly common in this part of the country. However, vaccination delays are still present and should be addressed to improve health care.