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Hend Alotaibi,1 Reem Alsergani,1 Amer Abdulaziz Alharbi,1 Khalid Nabil Nagshabandi,1 Asma Ahmed Almubark2 1Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, King Faisal University, Al-Ahsa, Saudi ArabiaCorrespondence: Khalid Nabil Nagshabandi, Department of Dermatology, College of Medicine, King Saud University, PJ7C+89Q, Riyadh, 12372, Saudi Arabia, Tel +966-582940888, Email khaloed23@gmail.comAbstract: Fixed drug eruptions (FDEs) are dermatological manifestations characterized by recurrent lesions at the same site upon re-exposure to the causative drug. We present a novel case of a 32-year-old female who developed bilateral symmetrical erythematous papules on her thighs following the use of chlorzoxazone for chronic back pain. This case is particularly significant as it underscores the potential for this specific drug, which is commonly prescribed, to induce FDE—a reaction previously unreported in the literature. The findings emphasize the necessity for clinicians to maintain a high index of suspicion for drug-induced skin reactions, even with medications considered safe and routinely used. This case serves as a critical reminder of the importance of thorough medication history assessments and the potential implications of drug interactions in dermatological care.Keywords: acetaminophen, chlorzoxazone, drug-induced fixed eruption, pain management, paracetamol, skin hypersensitivity, symmetrical skin lesions

Mohammad A Jareebi,1 Ahmad Y Alqassim,1 Saja A Almraysi,1 Weaam A Alfaifi,1 Taif A Masri,1 Rana S Alaki,1 Wasan M Qawfashi,1 Khairiah Ibrahim Nehari,1 Sawsan B Hakami,1 Ibrahim M Gosadi,1 Mohammed A Muaddi,1 Abdullah A Alharbi,1 Anwar M Makeen,1 Sarah MA Salih,1 Ali Abdullah Masmali2 1Department of Family and Community Medicine, Jazan University, Jazan, Saudi Arabia; 2Department of Jazan Health Affairs, King Fahd Central Hospital, Jazan, Saudi ArabiaCorrespondence: Mohammad A Jareebi, Department of Family and Community Medicine, Jazan University, Jazan, Saudi Arabia, Email mjareebi@jazanu.edu.saBackground: Despite deep cultural traditions, incense burning significantly impacts respiratory health. Effects of Arabian bakhour remain unknown in Saudi Arabia’s Jazan region with prevalent use. This cross-sectional study addresses this gap by investigating bakhour exposure and respiratory diseases.Methods: This was descriptive cross-sectional study conducted in Jazan area, Saudi Arabia, from October 2023 to March 2024. A total of 1612 participants age more than 18 years, both gender and resident of Jazan Area were included. Those aged less than 18 years were excluded. SPSS v 26 was used for data analysis.Results: The sample (n=1612) had a mean age of 29± 11 years and was 63% female. Bakhour use was nearly universal (98%), especially using coal (73%). Higher bakhour frequency significantly associated with increased cough (p< 0.01) and dyspnea (p< 0.01). Certain bakhour types linked to greater allergic rhinitis prevalence (p< 0.01). Regression analysis revealed cough during bakhour use worsened respiratory health (increased respiratory score) by 3.89 times (95% CI 1.13– 6.64; p=0.006) while dyspnea increased the score by 7.48 times (95% CI 4.70– 10.25; p< 0.001).Conclusion: This study provides valuable insights into the association between Bakhour use and respiratory health in the Jazan region. The findings emphasize the need for further research and public health interventions to mitigate potential respiratory risks associated with Bakhour use.Keywords: bakhour, respiratory health, cough, dyspnea, allergic rhinitis, household air pollution, environmental health

Nada J Alghamdi,1,&ast; Serene R Almuhaidib,2,&ast; Abdulmajeed S Alharbi,2,&ast; Abdullah Ali N Aljalfan,1,&ast; Khalid M Al-Husain1 1Department of Dermatology, King Fahd University Hospital, Al Khobar, Saudi Arabia; 2College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Abdullah Ali N Aljalfan, Department of Dermatology, King Fahd University Hospital, P.O. Box 34246, Al Khobar, Saudi Arabia, Email A.jalfan7@hotmail.comAbstract: Zoledronic acid is a bisphosphonate that can be administered intravenously and used to treat several bone disorders. It decreases bone resorption, thereby improving bone mineral density (BMD) and reducing fractures. The Food and Drug Administration (FDA) has approved zoledronic acid for the prevention and treatment of osteoporosis in postmenopausal females and males and for other conditions. Zoledronic acid is generally well tolerated, with most side effects being musculoskeletal or gastrointestinal. Cutaneous side effects include maculopapular rash and other mild skin reactions. Rare severe skin rashes, such as toxic epidermal necrolysis, have been reported. Here, we report the case of a 64-year-old female with a medical history of breast cancer status post-radical mastectomy and chemotherapy presenting with delayed hypersensitivity reaction to a hyaluronic acid dermal filler two days after receiving zoledronic acid intravenously given to maintain bone density, symptoms completely resolved with oral prednisolone 20 mg once daily and cetirizine 10 mg. Cases of delayed inflammatory reaction to hyaluronic acid soft tissue filler have previously been reported in patients who have received vaccination or those with viral infections. However, to our knowledge, there have been no reports of delayed inflammatory reactions to facial hyaluronic acid injections after zoledronic acid administration.Keywords: delayed inflammation, filler, zoledronic acid, hyaluronic acid

Nawfal A Aljerian,1,2 Abdullah A Alharbi,3 Hani A Alghamdi,4 Meshary S Binhotan,5,6 Reem S AlOmar,7 Ali K Alsultan,1 Mohammed S Arafat,1 Abdulrahman Aldhabib,1 Mohammed K Alabdulaali1 1Medical Referrals Centre, Ministry of Health, Riyadh, Kingdom of Saudi Arabia; 2Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 3Family and Community Medicine Department, Jazan University, Jazan, Kingdom of Saudi Arabia; 4Department of Family and Community Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 5Emergency Medical Services Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; 6King Abdullah International Medical Research Centre, Riyadh, Kingdom of Saudi Arabia; 7Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi ArabiaCorrespondence: Hani A Alghamdi, Department of Family and Community Medicine, College of Medicine, King Saud University, P.O Box 12372, Riyadh, 7065, Kingdom of Saudi Arabia, Tel +966507022266, Email Halhajalah@ksu.edu.saBackground: E-referral systems, streamlining patient access to specialists, have gained global recognition yet lacked a comparative study between internal and external referrals in Saudi Arabia (KSA).Methods: This retrospective study utilized secondary data from the Saudi Medical Appointments and Referrals Centre system. The data covers 2020 and 2021, including socio-demographic data, referral characteristics, and specialties. Logistic regression analysis was used to assess factors associated with external referrals.Results: Out of 645,425 e-referrals from more than 300 hospitals, 19.87% were external. The northern region led with 48.65%. Males were 55%, and those aged 25– 64 were 56.68% of referrals. Outpatient clinic referrals comprised 47%, while 61% of referrals were due to a lack of specialty services. Several significant determinants are associated with higher rates of external referral with (p-value < 0.001) and a 95% Confidence interval. Younger individuals under 25 exhibit higher referral rates than those aged 25– 64. Geographically, compared to the central region, in descending order, there were increasing trends of external referral in the northern, western, and southern regions, respectively (OR = 19.26, OR = 4.48, OR 3.63). External referrals for outpatient departments (OPD) and dialysis services were higher than for routine admissions (OR = 1.38, OR = 1.26). The rate of external referrals due to the lack of available equipment was more predominant than other causes. Furthermore, in descending order, external referrals for organ transplantation and oncology are more frequent than for medical specialties, respectively (OR = 9.39, OR = 4.50).Conclusion: The study reveals trends in e-referrals within the KSA, noting regional differences, demographic factors, and types of specialties regarding external referrals, benefiting the New Model of Care for the 2030 Vision. Findings suggest expanding virtual consultations to reduce external referrals. Strengthening primary care and preventive medicine could also decrease future referrals. Future studies should assess resource distribution, including infrastructure and workforce, to further inform healthcare strategy.Keywords: e-referrals, health policy, epidemiology, public health

Abeer Alharbi, Mohammed Aljuaid Health Administration Department, Business Administration College, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Abeer Alharbi, Email aalharbi15@ksu.edu.saObjective: This scoping review aims to identify and summarize existing evidence concerning the quality and capacity of PHC services in the Kingdom of Saudi Arabia (KSA) with a focus on the patients and healthcare professionals’ perceptions of PHC.Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The digital library, PubMed, and the search engine Google Scholar were searched to broaden our results for primary research involving patient and/or health professionals’ perspectives on Primary Healthcare in KSA.Results: A total of 38 publications were selected for the scoping review. Several studies examined patients’ overall satisfaction with PHC services (n=14) while others focused their investigation on specific services provided by PHC (n=3). Several studies assessed the perceptions of certain groups of patients (n=5). Several studies examined health professionals’ perceptions of the use of electronic health records (n=3), the safety culture (n=2), communicable disease management (n=1), emergency services (n=1), laboratory services (n=1), cost-effectiveness (n=1), and leadership (n=1). This review also included studies that assessed the health professionals’ job satisfaction and burnout (n=6).Conclusion: Patients were satisfied with some aspects of PHC services while recognizing that improvements in some areas were needed. These included waiting time, physician–patient communication, access to the services in rural areas, patient involvement in disease management, and oral health. Health workers were positive about certain quality aspects and services provided by PHC such as EHRs, safety culture, communicable disease management, emergency services, and laboratory services. Health workers demonstrated a low level of job satisfaction due to several reasons, including, working conditions, financial incentives, and burnout.Keywords: primary health care, patients, health professionals, perceptions, satisfaction, Saudi Arabia, PRISMA

The current study investigated fatwa discourse to reveal the attitudes and rulings of scholars towards English. In doing so, English and Arabic fatwas were analyzed employing modality. It was found that deontic auxiliary modals and similarly functioning markers were utilized to represent acceptance through median value modals to express obligation, for example, “should,” often followed by a justification, and low value modals to express permissibility, for example, “may.” Modality is also used to show resistance through a median value modal, such as “should” and “can.” The manipulation and power of such discourse are evident in the use of modality markers, including auxiliary, semi-auxiliary, and conditional modals. They function on the opposite poles of rulings, permissible and impermissible, to hedge permission and cast hesitation or uncertainty; yet, they show a lack of commitment on the part of the scholars to their fatwa, thus mitigating acceptance and resistance.

Ghada Awad Aljuhani,1 Rahaf Afandi,2 Aaesha A Alkayyal,2 Jana Alharbi,2 Abeer Surihan Alharbi,3 Mohammed Alsaedi,3 Haneen AlHujaili3 1Ophthalmology department, Saudi Commission for Health Specialties, Madinah, Saudi Arabia; 2Medical Intern, Taibah University, Madinah, Saudi Arabia; 3Ophthalmology Department, Ohud Hospital, Madinah, Saudi ArabiaCorrespondence: Ghada Awad Aljuhani, Email Ghada.aljuhani92@gmail.comIntroduction: Complementary and alternative medicine (CAM) includes all healthcare practices that are not part of conventional medicine. One of the most common eye disorders for visiting an ophthalmology clinic is dry eye disease (DED), and due to the increasing number of CAM used for eye conditions, 1 in 5 patients has been reported in previous studies to use CAM for eye treatment. This study aimed to estimate the prevalence of CAM use among patients with (DED).Methods: A web-based survey was used to collect the data, the first part of the questionnaire was about demographic data, and the second part included a validated Arabic version of the ocular surface disease index (OSDI). The third part was about practices that alleviate DED other than conventional medicine.Results: The total sample was 282, 61 were males, and 221 were females. Most participants (48.5%) were between 25 and 44 years old, 90% were Saudi, and only 10% were non-Saudi. Of the participant, 70% reported having attained a university or higher education level. The prevalence of the use of CAM among patients with dry eye was around 85%. The most frequently reported type of CAM used among the participants was faith healing (Ruqyah) (41%). This was followed by warm compressors (37%). There was no significant correlation between the severity of OSDI and using CAM, as the p-value was 0.909.Conclusion: In conclusion, our study shows that CAM is a popular choice among patients with dry eye syndrome. Faith healing and warm compressors are the most used types of CAM. However, the lack of correlation between OSDI severity and CAM use indicates that patients may use CAM for reasons other than symptom severity. Further research is needed to explore the reasons behind CAM use and its effectiveness in managing dry eye syndrome.Keywords: dry eye, complementary medicine, alternative medicine

Wajid Syed,1 Asma Awadh AlHarbi,2 Osama A Samarkandi,3 Abdullah M Alobaid,4 Ibrahim Nasser Alsulaihim5 1Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia; 2Department of Nursing, College of Nursing King Saud University, Riyadh, 11451, Saudi Arabia; 3Department of Basic Sciences, Prince Sultan College for Emergency Medical Services, King Saud University, Riyadh, 11466, Saudi Arabia; 4Department of Accident and Trauma, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh,Saudi Arabia; 5Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi ArabiaCorrespondence: Wajid Syed, Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia, Email Wali@ksu.edu.saBackground: The incidence of stroke is increasing in everyday life as a result of modifiable cerebrovascular risk factors and aging. Therefore, the goal of this study was to assess knowledge of the risk factors, and warning signs, of stroke and to determine associated demographic factors among individuals living in Riyadh, Saudi Arabia.Methods and Materials: A cross-sectional online study using a convenience sampling of general population living in Riyadh was carried out over three months in 2023 using a series of questionnaires that was adopted from the previous study. Before data collection, the study tool was subjected to pilot testing among a small sample of individuals to validate for consistency and reliability. The data was collected using social media platforms. A statistical package for the social science (SPSS version 27) was used.Results: Four hundred and sixty-two individuals completed the survey. Among those 69.5%, identified hypertension as a risk factor for stroke followed by hyperlipidemia (42.9%), heart disease (44.8%). In addition, most of the respondents (n = 332, 71.9%) knew that numbness or weakness of the face and/or limbs of the body was a warning sign of stroke. In this, 73.5% (n=249) of the respondents agreed that if they saw an individual suffering from a stroke, they would like to take the patient to the hospital immediately. However, there was a significant association between the knowledge of the respondents about the risk factor of stroke and educational degree (p=0.011), and parents working in healthcare settings (p =0.015).Conclusion: In conclusion it was observed that a significant respondents had an adequate knowledge of stroke risk factors, while most were unaware of the early warning signs of a stroke. To promote primary prevention and early management/outcomes, we advise that future regional campaigns focus on raising knowledge and recognition of stroke symptoms.Keywords: risk factors, hypertension, warning signs, treatment, stroke, sedentary life style

Reem S AlOmar,1 Nouf A AlShamlan,1 Marwa Mahmoud Shafey,1 Assim M AlAbdulKader,1 Khalid S AlHarkan,1 Wejdan M Al-Johani,1 Sameerah Motabgani,1 Nourah K Alkaltham,1 Abdullah A Alharbi2 1Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi ArabiaCorrespondence: Reem S AlOmar, Email rsomar@iau.edu.saIntroduction: COVID-19 remains a public health concern. Vaccinations, testing and tracing have been proven to provide strong protection against severe illness and death. Older adults are amongst the groups with an increased risk of severe illness. This study aimed to explore the willingness and hesitancy of the elderly population in the Kingdom of Saudi Arabia to test and vaccinate against COVID-19.Methods: This cross-sectional study targeted participants aged 65 years and above. The questionnaire included both sociodemographic variables, and variables related to willingness and hesitancy to vaccinate and test for COVID-19 that were mainly based on existing literature. Bivariate analyses were performed to test for associations. Significance was set at the 0.05 level.Results: The total sample of respondents was 502. The results show that 52.4% were not aware of a previous infection. Participants aged above 70 years and females were found to be more aware of a previous infection (51.6% and 53.1% respectively) (P < 0.05). Also, 54.7% felt it necessary to test against COVID-19, and among those, 70.8% believed that testing would contain and control the spread. The results also show that 3.2% were not vaccinated to date, compared to 95.41% who had the complete dose as well as the recommended booster dose for elderlies. Age, sex and level of education were significantly associated with vaccine uptake, where participants aged between 65 and 70 years, males and high levels of education were associated with a complete vaccine uptake.Discussion: The current findings add to the epidemiological evidence and show that the social network theory within the context of health may have played a role in self-awareness of previous infections. Also, social factors should be incorporated in public health interventions and public health campaigns targeting the elderly are still needed especially with the continued discovery of variants of interests.Keywords: COVID-19, public health, health promotion, prevention, elderly

Naif K Binsaleh,1,2 Reem Eltayeb,1 Subuhi Sherwani,2,3 Ali A Almishaal,4 Emad A Hindi,5 Husam Qanash,1,2 Abdulrahman S Bazaid,1 Abdulmajeed Owayed Alharbi,6 Mohammed B Bazaid,7 Shayaa Alsaadi Altamimi8 1Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail, Saudi Arabia; 2Medical and Diagnostic Research Centre, University of Ha’il, Hail, 55476, Saudi Arabia; 3Department of Biology, College of Sciences, University of Hail, Hail, Saudi Arabia; 4Department of Speech-Language Pathology and Audiology, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia; 5Department of Clinical Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 6Laboratory Department, King Fahad General Hospital, Jeddah, Saudi Arabia; 7Pediatric Department, East Jeddah Hospital, Jeddah, Saudi Arabia; 8Quality Department, King Khalid Hospital, Hail, Saudi ArabiaCorrespondence: Naif K Binsaleh, Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, P.O. Box 2440, Hail, Saudi Arabia, Tel +966505274077, Email n.binsaleh@uoh.edu.saObjective: Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a communicable disease transmitted through the respiratory route and bodily contact. The severity of infection and mortality rate of COVID-19 cases was significantly high in the initial stages of the pandemic. This study aims to investigate the hematological profile of COVID-19 survivors and non-survivors.Methods: This is a single-center retrospective study. A total of 108 hospitalized patients with laboratory-confirmed COVID-19 at East Jeddah Hospital between April and August 2020 were categorized into two groups based on outcome as survivors (n = 54) and non-survivors (n = 54). Hematological parameters and clinical profiles were analyzed and compared between the two groups.Results: The mean age and standard deviation of the survived (30– 71 years) and non-survived (33– 83) groups was 53 ± 10.8 and 57.9 ± 12.2 years, respectively, with no statistically significant difference in age between groups (p = 0.0513). Non-survivors had a significantly longer median length of stay in the intensive care unit (ICU) (7 days, IQR: 4.24 to 12) compared to survivors COVID-19 patients (5 days, IQR: 0 to 11.75) (p = 0.0151). For the survivors group, the participant’s age positively correlated with the length of hospital stay (r(52) = 0.21, p = 0.0005) and ICU length of stay r(52) = 0.18, p = 0.001). The median red blood cells (RBC) counts were significantly higher in the survived group (4.56x109/L, IQR: 4.02 to 5.11) in comparison with the non-survived (4.23x109/L, IQR: 3.75 to 4.23) group (p = 0.0011). All COVID-19 patients exhibited lymphocytopenia and a significant negative correlation was observed between the lymphocyte values and length of hospital stay among the survived group (p < 0.001) as well as length of ICU stay among the survived group (p < 0.0480). Disease-related mortality was significantly associated with reduced white blood cells (WBCs) (8.5× 109/L, IQR: 6.1 to 11.7) and reduced basophils (0.09%, IQR: 0.02 to 0.19). Additionally, statistically significant differences were found between the survived and non-survived groups with respect to prothrombin time (PT) (12.5 sec. vs 14 sec., p < 0.0001) and partial thromboplastin time (PTT) (31.8 sec. vs 40 sec., p = 0.0008).Conclusion: Hematological parameters can serve as valuable indicators to identify patients with severe COVID-19 and expected poor-prognosis/outcomes upon hospital admission. Cell counts of lymphocytes, WBCs, basophils and parameters such as PT and PTT can serve as clinical indicators to assess disease severity and predict progression to critical illness.Keywords: SARS-CoV-2, hematology, COVID-19

In Sub-Saharan Africa, zoonotic diseases are the leading cause of sickness and mortality, yet preventing their spread has long been difficult. Vaccination initiatives have significantly reduced the frequency of zoonotic diseases mostly in African regions. Nonetheless, zoonotic illnesses continue to be a hazard to underdeveloped countries. Zoonotic infections are spread by direct contact, food, and water. We construct an epidemic model to understand zoonotic disease transmission phenomena. The model is examined using the fundamental results of fractional theory. The reproduction parameter ℛ0{{\mathcal{ {\mathcal R} }}}_{0} was obtained by inspecting the model’s steady states. The stability of the system’s steady states has been demonstrated. The system’s reproduction parameter is quantitatively explored by varying various input parameters. Furthermore, the presence and uniqueness of the solution of the proposed dynamics of zoonotic diseases have been demonstrated. Different simulations of the recommended zoonotic disease model with different input factors are performed to inspect the complex dynamics of zoonotic disease with the influence of various model factors. To establish effective prevention and control measures for the infection, we analyse dynamical behaviour of the system. Decreasing the fractional order θ\theta can decrease the infection level significantly. Different factors for reducing zoonotic diseases were recommended to regional policymakers.

Ahmed Hussein Subki,1 Manal Ismail Bokhary,1 Sultan Abdulrahman Alandijani,1 Mohannad Abdulrahman Aljehani,1 Ahmed Wasel Alharbi,1 May Alzahrani,1 Saud Suliman Almuhammadi,2 Bassim Tahseen Albeirouti,3 Mohamed Abdulmajid Abduljabar,1 Silvio Danese4 1Department of Internal Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia; 2Department of Surgery, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia; 3Adult Hematology/Bone Marrow Transplant (BMT) Section, Department of Oncology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia; 4Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, ItalyCorrespondence: Ahmed Hussein Subki; Manal Ismail Bokhary, Department of Internal Medicine, King Faisal Specialist Hospital & Research Centre, P.O.Box No 40047, Jeddah, 21499, Saudi Arabia, Email subki.research@gmail.com; mbokhary@kfshrc.edu.saIntroduction: Hypereosinophilic syndrome (HES) and immune thrombocytopenic purpura (ITP) have been reported to co-occur with ulcerative colitis (UC). However, the exact pathogenic mechanisms of their occurrence remain elusive. In this article, we aim to describe two cases of UC patients who developed refractory HES and ITP and elaborate on their potential pathogenesis.Case Study: We report two middle-aged patients diagnosed with UC. The first patient developed HES that was refractory to conventional medical therapy of idiopathic HES, and the second developed refractory ITP that failed steroid and immunosuppressive therapy. Both conditions improved considerably following colectomy, suggesting they are of a reactive rather than idiopathic nature.Conclusion: In patients with UC and refractory comorbid HES or ITP, the reactive nature of these comorbidities should be taken into consideration, and colectomy, therefore, should be considered if clinically indicated.Keywords: hypereosinophilic syndrome, immune thrombocytopenic purpura, colectomy, ulcerative colitis

Zeead AlGhamdi,1 Shaya Y Alqahtani,2 Khalid AlDajani,1 Ammar Alsaedi,1 Omar Al-Rubaish,1 Abdulmajeed Alharbi,1 Hatem Elbawab1 1Thoracic Surgery Division, Department of Surgery, College of medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Internal Medicine and Critical Care Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Zeead AlGhamdi, Thoracic surgery division, Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, Tel +966504845350, Email zghamdi@iau.edu.saBackground: Previous studies have been conducted to assess pneumothorax. However, few studies were done to assess pneumothorax in COVID-19 patients in the intensive care unit (ICU).Objective: Our aim is to describe and analyze the prevalence, clinical characteristics, risk factors, and outcomes of COVID-19 pneumothorax patients in the intensive care unit.Methods: We performed a retrospective review of the medical records of 418 patients, who tested positive for COVID-19 by polymerase chain reaction test and required ICU admission in King Fahad Hospital of The University from 02/01/2020 to 01/09/2021. A total number of 36 pneumothorax patients were included in the study.Results: Of 418 patients who were followed up in the intensive care unit as COVID-19 cases, 36 patients developed a pneumothorax (8.61%). The mean age of the patients was 55.6 ± 15.06 years, 23 patients were male, and 13 were female. Seventeen patients were obese, and only one patient was an active smoker. Twenty-four patients had at least one comorbidity; hypertension was the most common. Thirty-two patients were intubated, and the duration of intubation was 23.23 ± 15.9 days. The time from intubation to pneumothorax development was 8.8 ± 9.3 days. Six patients were on bilevel positive airway pressure ventilation (BIPAP), 2 patients on continuous positive airway pressure ventilation (CPAP), 3 patients on High-Flow Nasal Cannula ventilation (HFNC), 9 patients on pressure-control ventilation (PC), and 16 patients on pressure regulated volume control ventilation (PRVC). Of 36 patients, 26 died, and the mortality rate was 72.2%.Conclusion: Our study showed that risk factors of pneumothorax occurrence in COVID-19 critically ill patients include male patients, hypertension, diabetes mellitus, endotracheal intubation and mechanical ventilation. More efforts should be made to determine the risk factors and assess the outcomes of those patients to develop preventive measures and management guidelines.Keywords: pneumothorax, COVID-19, intensive care unit, risk factors, outcomes

Ahmad A Alharbi,1,2 Abdullah A Alharbi,2,3 Dhafer Salem Bashen,2 Tarek Owaidah4 1Pathology Department, College of Medicine, Majmaah University, Al Majmaah 11952, Riyadh, Kingdom of Saudi Arabia; 2Laboratory Department, Dr. Sulaiman Al-Habib Hospital in Al Takhassusi, Riyadh, Kingdom of Saudi Arabia; 3Pathology Department, College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia; 4Hematology and Transfusion Medicine Department, Alfaisal University, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Tarek Owaidah, Consultant Hematology and Transfusion Medicine, Alfaisal University, P.O.Box 5092, Riyadh, 11533, Kingdom of Saudi Arabia, Tel +966 50 531 2925, Email towaidah@gmail.comBackground: Iron supplementation is administered orally or intravenously to treat iron-deficiency anemia (IDA). Ferric Carboxymaltose (FCM) “Ferinject®” is an intravenous (IV) iron preparation that has emerged as a safe therapeutic option for treating IDA in the past decade.Aim: This study aimed to evaluate safety and efficacy of carboxymaltose in a cohort of patients with IDA not responding to oral therapy.Methods: This 12-month retrospective study included 106 patients with IDA, with-or without bariatric surgery, who received (single or multiple doses) of Carboxymaltose 500mg/10mL. Data points included patients’ demographics, baseline data for Hb, platelet, ferritin, and MCV pre–and at 1, 2, and 3 months following different doses of IV-Carboxymaltose. Changes in Hb, MCV, platelets, and ferritin levels were recorded in response to Carboxymaltose to assess the optimal dose, risk of hyperferritinemia, and hypophosphatemia.Results: At three months (95 days) follow-up, the median change pre-and post-therapy in hemoglobin was from 9.5 to 11.9g/dL (p < 0.01), MCV 73.6– 80.5fL (p < 0.01), and ferritin 5.3– 93.8ng/mL. A significant difference was observed between platelet count of patients who underwent bariatric surgery and those who did not. An optimal ferritin response (> 30ng/mL) was observed in 87.8% of patients who received first dose, and none of the full three doses showed no response. 37% of patients who received two doses developed hyperferritinemia. Serum phosphate levels were assessed in 28 cases, and hypophosphatemia was observed in 25% of these patients.Conclusion: Carboxymaltose is a reliable option for IDA. IV-FCM therapy helps achieve significant improvement in hemoglobin concentration and MCV from the first dose carrying a low reversible risk of hyperferritinemia following multiple doses. An interesting finding of this study is the discovery of a population of IDA patients requiring periodic assessment for iron reinfusion to sustain normal levels, mostly post-bariatric surgery. Changes in serum phosphate levels reported to occur consecutively with FCM treatment should be further studied.Keywords: iron deficiency, anemia, ferrous carboxymaltose, hypophosphatemia

Abdullah A Alharbi,1 Khalid I Alqumaizi,2 Ibrahim Bin Hussain,3– 5 Nasser S AlHarbi,6 Abdulmalik Alqahtani,7 Wala Alzawad,8 Hussam M Suhail,9 Mohammed I Alamir,9 Mohammed A Alharbi,9 Hamad Alzamanan10 1Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia; 2Family Medicine Department, Faculty of Medicine, AlMaarefa University, Riyadh, Saudi Arabia; 3Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 4Department of Pediatrics, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia; 5Southern Business Unit, Health Holding Company Project, Healthcare Transformation, Vision Realization Office, Ministry of Health, Riyadh, Saudi Arabia; 6Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Ophthalmology Department, Prince Sultan Medical Military City, Riyadh, Saudi Arabia; 8Eastern Business Unit, Health Holding Company Project, Healthcare Transformation, Vision Realization Office, Ministry of Health, Khobar, Saudi Arabia; 9Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia; 10The Vision Realization Office (VRO), Ministry of Health, Riyadh, Saudi ArabiaCorrespondence: Abdullah A Alharbi, Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, 45142, Jazan, Saudi Arabia, Tel +966556966880, Email aaalharbi@jazanu.edu.saObjective: To assess the length of stay (LoS) variation for COVID-19 inpatients among the four regions of the Southern Business Unit (SBU).Methods: This is a comparative retrospective study of the LoS of COVID-19 inpatients in the four regions of the SBU in the KSA. Data was collected from the Ministry of Health (MoH) in all hospitals in the SBU. Participants were all patients admitted with confirmed COVID-19 between March 2020 and February 2021. Variables included region (variable of interest), demographics, comorbidities, and complications. Multilinear regression was performed to control for any factors that might have had an association with LoS.Results: The mean LoS of the total sample was 10 days and Bisha (the reference) was 7 days. Compared to Bisha, LoS in Jazan was 34% longer, in Najran 62% longer, and Aseer 40% longer. We observed that other factors also had an association with LoS, compared to Bisha, compared to the references, Saudi patients had a 15% shorter stay; admission to ICU increased LoS by 57%; patients who died during hospitalization had a 39% shorter LoS; the complications from COVID-19 of acute kidney injury and ARDS increased LoS by 22% and 48% respectively.Conclusion: After statistically controlling for confounders, this study reveals that LoS was significantly impacted by region in the SBU in the KSA. We recommend that further study be conducted to illuminate the underlying causes of this variation which may be organizational or structural to ensure high quality of care, access to care, and equity of resources throughout all regions of the SBU in accordance with the new Model of Care in Vision 2030.Keywords: COVID-19, length of stay, Southern Business Unit, Health Holding Company, KSA

Abdullah A Alharbi,1 Khalid I Alqumaizi,2 Ibrahim Bin Hussain,3– 5 Abdullah Alsabaani,6 Amr Arkoubi,7 Abdulaziz Alkaabba,8 Arwa AlHazmi,5 Nasser S Alharbi,9 Hussam M Suhail,10 Abdullah K Alqumaizi11 1Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia; 2Family Medicine Department, Faculty of Medicine, AlMaarefa University, Riyadh, Saudi Arabia; 3Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 4Department of Pediatrics, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia; 5Southern Business Unit, Health Holding Company Project, Healthcare Transformation, Vision Realization Office, Ministry of Health, Riyadh, Saudi Arabia; 6Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia; 7Department of Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 8Department of Family Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 9Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 10Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia; 11College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi ArabiaCorrespondence: Abdullah A Alharbi, Family and Community Medicine Department, Faculty of Medicine, Jazan University, 12501 Dar Al-Nassr St., Abu Arish, Jazan, 45911, Saudi Arabia, Email aaalharbi@jazanu.edu.saBackground: This is the first descriptive and comparative study conducted of COVID-19 inpatients from multi-centers in the four administrative southern regions and proposed Southern Business Unit (Jazan, Najran, Bisha, and Aseer) of the Kingdom of Saudi Arabia (KSA).Methods: Participants were 809 randomly selected patients admitted to the eight sampled hospitals with confirmed COVID-19 between March 2020 and February 2021. We assessed and compared socio-demographics, clinical characteristics, and clinical outcomes of the four regions.Results: Socio-demographic and clinical characteristics of the participants are a mean age of 60 ± 17.7 years, 70% Saudi male, the prevalence of diabetes (DM2) 58%, hypertension (HTN) 48%, obesity 43%, cardiac diseases 15%, and immunity or cancer diseases almost 1%. The prevalence of complications during admission were bacterial pneumonia 65%, acquired respiratory distress syndrome (ARDS) 32%, sepsis 20%, multi-organ failure 18%, acute kidney diseases 15%, and arrhythmia 4%. Clinical outcomes were: admitted to intensive care unit (ICU) 52%, mortality rate 25%, referred to other facilities 9%, and mean length of stay (LOS) was 11± 9.5 days. We observed statistically significant variation in many variables among the four regions. Najran and Aseer had a higher prevalence of risk factors for severity including age and comorbidities accompanied by higher rates of complications, ICU admissions, LOS, and mortality. Bisha and Jazan had lower prevalence of risk factors and LOS with lower rates of complications, ICU admissions, and mortality.Conclusion: This study reveals that the geographic region in which the patient was cared for was related to the severity and outcome of COVID-19 infection. Policy makers should search for solutions to regional differences in underlying health conditions such as DM2, HTN, and obesity to plan for improvements in preventive care as well as resource distribution to ensure quality for all Saudi citizens. This study will serve as guidance to begin to form strategies for these improvements as envisioned in the future New Model of Care.Keywords: COVID-19, inpatient characteristics, demographic and clinical characteristics, clinical course, outcomes, and complications, Southern Business Unit, Saudi Arabia

Naveed Ahmed,1 Mohmed Isaqali Karobari,2– 4 Anam Yousaf,5 Roshan Noor Mohamed,6 Sohaib Arshad,7 Syed Nahid Basheer,8 Syed Wali Peeran,9 Tahir Yusuf Noorani,4 Ali A Assiry,10 Abdulaziz S Alharbi,11 Chan Yean Yean1 1Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Malaysia; 2Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, 12211, Cambodia; 3Center for Transdisciplinary Research (CFTR), Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai, Tamil Nadu, 600077, India; 4Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kota Bharu, Kelantan, 16150, Malaysia; 5Department of Pathology Laboratory, Pakistan Kidney and Liver Institute & Research Center, Lahore, Pakistan; 6Department of Pediatric Dentistry, Faculty of Dentistry, Taif University, Taif, 21944, Saudi Arabia; 7Periodontics Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia; 8Division of Operative Dentistry, Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia; 9Department of Periodontics, Armed Forces Hospital Jizan, Jizan, Kingdom of Saudi Arabia; 10Preventive Dental Science Department, Faculty of Dentistry, Najran University, Najran, Kingdom of Saudi Arabia; 11Saudi Board of Pediatric Dentistry (SB-PD), King Fahad Military Medical Complex – KFMMC, Dammam, Saudi ArabiaCorrespondence: Mohmed Isaqali Karobari, Department of Restorative Dentistry & Endodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, 12211, Cambodia, Email dr.isaq@gmail.com Chan Yean Yean, Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Malaysia, Email yychan@usm.myAbstract: Introduction: Ginger (Zingiber officinale) has been one of the most commonly consumed herbal medicines for a long time to treat several common diseases. Antibacterial activity, antioxidant properties and many bioactive compounds in ginger have been identified previously, which could be used as an alternative method to treat many infectious diseases.Methods: The current study evaluates ginger’s biochemical profile using qualitative and quantitative analysis and its bioactive potentials using antioxidant and antimicrobial assays against Streptococcus mutans and selective oral microbes. HPLC analysis was performed for the quantitative analysis. DPPH and disc diffusion assays were used for antioxidant and antimicrobial activities. The antimicrobial activity was checked against Streptococcus mutans, Enterococcus faecalis, Staphylococcus spp., and Lactobacillus spp. All solvents were removed by rotary evaporation before testing the dried extracts.Results: The observed IC50 value showed that distilled water extract exhibited the highest antioxidant activity (43.9), followed by ethanol extract (52.4), and the lowest activity was observed in n-butanol extract (91.2) and n-hexane (90.6). Different plant extracts have shown significant antibacterial activity (p = 0.001) against each bacterium. The highest antibacterial activity against tested bacteria was observed in n-hexane, chloroform and ethanol extracts. In comparison, the ethyl acetate, n-butanol and water extracts showed low antibacterial activity.Conclusion: This study emphasizes that Zingiber officinale (Z. officinale) against Gram-positive bacteria is an effective antimicrobial herb. Furthermore, it can be used as a potential natural source of antioxidants. Further studies on the toxicity analysis of ginger are recommended.Keywords: Streptococcus mutans, ginger, dental, oral microbes, herbal medicine, medicinal plants, healthy food

Waleed Ahmed Alghamdi,1 Ahmed Hussein Subki,2 Hazim Abdulkarim Khatib,3 Nadeem Shafique Butt,4 Rahaf Ali Alghamdi,1 Mohammed Saad Alsallum,5 Ahmed A Alharbi,1 Mohammad Nasser Almatrafi,1 Abdullah Ahmed Alobisi,1 Faten Al-Zaben,1 Harold G Koenig1,6,7 1Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Internal Medicine, King Faisal Specialist Hospital & Research center, Jeddah, Saudi Arabia; 3Department of Internal Medicine, King Abdulaziz Hospital, Jeddah, Saudi Arabia; 4Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 6School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China; 7Duke University Medical Center, Durham, NC, USACorrespondence: Waleed Ahmed Alghamdi; Harold G Koenig, Email wagalghamdi@kau.edu.sa; harold.koenig@duke.eduBackground: The present study examined the prevalence of and risk factors for symptoms of body dysmorphic disorder (BDD) in the general population of Jeddah, a large port city in Saudi Arabia.Methods: This cross-sectional study surveyed a convenience sample of 520 adults. We used a validated self-screening measure to assess BDD, the body dysmorphic disorder questionnaire (BDDQ).Results: The prevalence of significant BDD symptoms among the general Saudi population was 8.8% (ie, those scoring above the cut off for BDD on the BDDQ). Over half (52%) of all respondents reported concerns about the attractiveness of their body parts, and of those expressing such concerns, 66% were preoccupied with these thoughts. Only 3% of all respondents opted for cosmetic surgery because of these concerns, and most of those individuals (69%) had only one surgery. Nearly 9% of all respondents reported that these concerns affected their relationships with family and friends. Almost 15% of all participants spent an hour or more each day thinking about these concerns. Patients who reported a history of depression were 3.8 times more likely to have BDD. Other variables included in the model predicting high BDD scores (eg, age, job status, and marital status) did not achieve statistical significance.Conclusion: Significant symptoms of BDD (based on the BDDQ) are not uncommon among the general population of Jeddah, Saudi Arabia. Risk factors for this condition were female gender, younger age, being unmarried, and in bivariate and multivariate analyses, history of depression and female gender. These findings underscore the need for increased awareness by clinicians of this disorder, particularly when treating patients with depressive disorder, particularly among women.Keywords: body dysmorphic disorder, body image, prevalence, Saudi Arabia

The heat transport and entropy formation of an unsteady Sutterby hybrid nanofluid (SBHNF) are investigated in this work. SBHNF’s flowing and thermal transport properties are investigated by exposing the nanofluid to a slippery hot surface. This analysis includes the influences of solid-shaped nanoparticles, porous materials, radiative flux, and viscous dissipative flow. The Galerkin finite element technique (G-FEM) is used to find self-similar solutions to equations that are then transformed into ODEs using appropriate transformations. This research considers two diverse kinds of nanosolid-particles, copper (Cu) and graphene oxide (GO), using non-Newtonian engine-oil (EO) as the working fluid. In the flowing, energy, skin friction, Nusselt number, and entropy production, important findings for the various variables are visually depicted. The most notable finding of the analysis is that when SBHNF (GO–Cu/EO) is compared to a typical nanofluid (Cu–EO), the thermal transmission rate of SBHNF (GO–Cu/EO) gradually increases. Furthermore, heat transfer is greatest for spherical-shaped nanoparticles and lowest for lamina-shaped nanoparticles. The entropy in the model is increased when the size of the nanoparticles ϕ\phi is increased. The comparable impact is noticed once the radiation flowing Nr{N}_{\text{r}} and Deborah number λ\lambda increase.

Hani B Albalawi,1 Faris Hashem,1 Amal Nafea J Alharbi,2 Naif M Alali,1 Wejdan Mohammed S Alshehri,2 Abdulrahman Arshed N Alharfy,2 Abdulmajeed Mousa M Alzahrani,2 Nouf Mohammed A Albalawi,2 Moustafa S Magliyah,3 Saad H Alenezi4 1Department of Ophthalmology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia; 2Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia; 3Department of Ophthalmology, Prince Mohammed Medical City, Aljouf, Saudi Arabia; 4Department of Ophthalmology, College of Medicine, Majmaah University, Almajmaah, Saudi ArabiaCorrespondence: Hani B AlbalawiDepartment of Ophthalmology, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia, Email hb.albalawi@ut.edu.saPurpose: This study aims to measure the knowledge levels toward retinopathy of prematurity (ROP) among pediatricians covering neonatal intensive care units (NICUs) in the major hospitals in Tabuk, Saudi Arabia. To our knowledge, this is the first report to assess the awareness level of ROP in the NICU pediatricians in the region.Patients and Methods: This is a quantitative, non-experimental, cross-sectional, descriptive study using self-administered electronic questionnaires to assess the knowledge level among NICU pediatricians at the main hospitals of Tabuk city. We used a self-administer online validated knowledge, attitude, and practice (KAP) questionnaire. A scoring system was implemented in the data analysis, depending on the correct chosen answers on the KAP questionnaire, to present the ROP knowledge level in the participants.Results: The study included 41 NICU pediatricians. Most of the participants’ age exceeded 40 years (51.2%). The majority were recruited from either King Salman Military hospital (34.1%) or King Khalid hospital (31.7%). The average frequency of preterm infants seen per month exceeded 15 infants among 41.4% of the respondents. Most pediatricians recognized the important treatment modalities available for ROP (92.7%); however, only 24.4% of them could recognize that 32 weeks or less is the gestational age of the screening criteria for ROP. The overall knowledge score ranged between 4 and 10, out of a possible maximum of 12 with a mean ± SD of (6.68± 1.47). The majority (75.6%) believe that the ROP treatment can successfully prevent blindness.Conclusion: Our study demonstrated that the NICU pediatricians have good knowledge about the treatment modalities of ROP. However, their knowledge about the inclusion criteria of ROP screening was insufficient. Thus, we highlighted the necessity of raising the awareness level and the strict application of the clinical guidelines among NICU pediatricians and healthcare workers involved in managing ROP.Keywords: retinopathy of prematurity, pediatricians, preventable, preterm infant, knowledge, attitude, practice, ROP

Abdullah A Alrasheed,1,2 Abdulrahman H Alharbi,3 Abdulrahman F Alotaibi,3 Abdulaziz H Alqarni,3 Abdullah M Alshahrani,4 Turky H Almigbal,1– 3 Mohammed A Batais1,2 1Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Family Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; 3Vision College of Medicine, Vision Colleges in Riyadh, Riyadh, Saudi Arabia; 4Department of Family Medicine, College of Medicine, University of Bisha, Bisha, Saudi ArabiaCorrespondence: Abdullah A AlrasheedDepartment of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia, Tel +966 55 644 0445, Email abdullahalrasheed03@gmail.comIntroduction: Patient–doctor communication is a fundamental component of patients’ care. Withholding important information to the doctor can negatively affect the patients’ health and patient–doctor communication.Aim: This study aimed to explore the fundamental types of information that patients hide from doctors, eg, the use of medication, health-related lifestyle, or disagreement with the doctor’s plan. In addition, this study examines the prevalence and reasons for this nondisclosure and factors associated with it.Methodology: An online survey was conducted using a self-designed questionnaire, which was distributed to social media, targeting the residents of Saudi Arabia from February 1, 2021 to February 28, 2021. Respondents under 18 years of age and those who provided incomplete/incorrect data were excluded from the study. Types of nondisclosed information and their reasons were evaluated.Results: A total of 2725 participants completed the questionnaire, and 1392 (51.1%) were males. About 43.2% of the participants were 18– 29 years. Most (82%) responded “yes” to the question “Have you ever withheld any information from your doctor?” Nondisclosed information commonly involved disagreements with the recommendation (44.7%), not taking prescription medication as instructed (40.6%), and not understanding the instructions (37.4%). The most frequent reasons (68.7%) for nondisclosure were that the participants wanted to undergo further tests, did not like the doctor’s attitude (48.7%) and felt it did not matter to the doctor (43.2%). Those under 40 were more apt to withhold information (70.4%) than older participants (29.6%) p value = 0.0034. Other factors like gender, education level, and marital status were not associated with nondisclosure.Conclusion: The prevalence of nondisclosure to doctors is high. Effective communication skills and sound doctor–patient relationships may reduce this risk and improve the care delivered to the patients.Keywords: nondisclosure, patient–doctor relationship, patient doctor communication, shared decision

This research investigates impediments to the successful implementation of Communicative Language Teaching (CLT) in Saudi English as a Foreign Language (EFL) classrooms. Going beyond typical discussions on teacher training and curriculum development, the study explores entrenched resistance stemming from traditional teaching methods among teachers and students. The examination system, emphasizing rote memorization and grammar, poses a significant obstacle to CLT's communicative goals. Sociocultural factors, including a conservative view of education and perceived threats to Arabic identity through English acquisition, contribute to the resistance. Conclusively, the research highlights the interconnectedness of these challenges, proposing that transforming English assessment methods could gradually reshape student perspectives and boost motivation for communicative language acquisition. The study advocates pragmatic solutions such as curriculum adjustments aligned with cultural norms, comprehensive teacher training, and adaptations to the testing system to evaluate real-life language use. These strategies aim to cultivate an environment conducive to CLT adoption in Saudi EFL classrooms, moving beyond theoretical considerations to actionable steps. The research underscores the need for ongoing exploration through future studies, assessing the long-term impact of these strategies on learner attitudes and language acquisition outcomes. It emphasizes a sustained commitment to refining language education practices in Saudi EFL contexts and beyond.

Ahmad H Mufti, 1 Imad A AlJahdali, 2 Nasser A Elhawary, 1 Samar N Ekram, 1 Iman Abumansour, 1 Ikhlas A Sindi, 3 Hind Naffadi, 4 Ezzeldin N Elhawary, 5 Najiah M Alyamani, 6 Ghydda Alghamdi, 1 Wafaa Alosaimi, 7 Ghufran Rawas, 8 Amaal Alharbi, 9 Mohammed T Tayeb 1 1Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia; 2Department of Community Medicine, College of Medicine, Umm Al-Qura University, Mecca, 21955, Saudi Arabia; 3Department of Biotechnology, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 4Common Science, First Year Deanship, Umm Al-Qura University, Mecca, Saudi Arabia; 5MS Genomic Medicine Program, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK; 6Department of Biology, College of Jeddah, Jeddah, Saudi Arabia; 7Department of Hematology, Maternity and Children Hospital, Mecca, Saudi Arabia; 8King Abdullah Medical City, Mecca, Saudi Arabia; 9Saudi Biobank National ProjectKing Abdullah International Medical Research Center, Jeddah, Saudi ArabiaCorrespondence: Nasser A ElhawaryDepartment of Medical Genetics, Faculty of Medicine, Umm Al-Qura University, P.O. Box 57543, Mecca, 21955, Saudi ArabiaTel +966 55 369 2180Email naelhawary@uqu.edu.saBackground: The antigen processing 1 (TAP1) and proteasome 20S subunit beta 9 (PSMB9) genes are associated with strong susceptibility to many autoimmune diseases. Here, we explored whether TAP1/PSMB9 genetic variants, individually or combined, affected susceptibility to the complex, autoimmune-based skin disorder vitiligo.Methods: Samples of genomic DNA from buccal cells of 172 patients with vitiligo and 129 healthy controls were analyzed using TaqMan™ genotyping assays for the TAP1 rs1135216 (A>G) and PSMB9 rs17587 (A>G) single nucleotide polymorphisms (SNPs). SNPStats software (https://www.snpstats.net) was utilized to choose the best interactive inheritance mode for selected SNPs.Results: The genotype frequencies for the TAP1 rs1135216 and PSMB9 rs17587 SNPs were in Hardy–Weinberg equilibrium for cases (P= 0.11 and P= 0.10, respectively) but not for controls (P< 0.05). The TAP1 rs1135216 (D637G) and PSMB9 rs17587 (R60H) SNPs increased the risk of vitiligo four-fold and two-fold, respectively (odds ratio [OR]= 4.6; 95% confidence interval [CI], 3.2– 6.5; P< 0.0001 and OR= 2.2; 95% CI, 1.5– 3.1; P< 0.0001). The recessive model (G/G-D/G versus D/D) and the codominant model (R/R versus R/H) were the best models of inheritance for the rs113526 and rs17587 SNPs, respectively (OR= 16.4; 95% CI, 2.0– 138; P= 0.0006 and OR= 1.7; 95% CI, 0.3– 1.8; P= 0.013). Vulgaris, focal vulgaris, and acryl/acrofacial were the most common vitiligo subtypes in our sample (51%, 21%, and 19%, respectively). Heterozygous rs113526 (637D/G) and rs17587 (60R/H) were the most common genotypes in most vitiligo subtypes. The heterozygous 637D/G genotype and the 637G variant allele were significantly more common in patients with active disease than in patients with stable disease (P= 0.000052 and P= 0.0063, respectively).Conclusion: Our findings suggest a crucial role for TAP1 rs1135216 and PSMB9 rs17587 in the risk and progression of vitiligo in the Saudi community. Genomic analyses are needed to identify more candidate genes and more genetic variants associated with vitiligo.Keywords: vitiligo, TAP1/PSMB9, single nucleotide polymorphisms, TaqMan genotyping, linkage disequilibrium

Mohammed Al-Hariri,1 Ahmed Alsunni,1 Mohammad Habeeb Shaikh,1 Tharwat Gamal Eldin,1 Kholoud Al Ghamdi,1 Abdulelah Fawzi Alharbi,2 Hussain Alhawaj,3 Shahanas Chathoth4 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Environmental Health, Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabi; 4Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Mohammed Al-HaririDepartment of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 2114-31451, Dammam, Saudi ArabiaTel +966 50-727-5028Email mtalhariri@iau.edu.saBackground: Caffeic acid phenethyl ester (CAPE) is a naturally occurring polyphenolic concentrated in propolis of honeybee hives. CAPE has been shown various physiological and pharmacologic properties. The aim of the present study was to investigate the effects of CAPE on proinflammatory markers in growing rats by performing the moderate swimming test.Methods: A total number of 21 male Wistar albino rats were separated into three groups (n = 7): sedentary: negative control group; exercise: positive control group received vehicle orally and exercise + CAPE: CAPE treated group: treated with CAPE (20 mg/kg) orally 30 min before exercise, for 5 days. The animals were left free to swim in the tank, 20 minutes/day for 5 days. At 24 hours after finishing the experiment, rats were euthanised and blood was collected to analyze the level of serum interleukin IL-6 and tumor necrosis factor–α (TNF-α).Results: Growing rats subjected to the moderate swimming test and in those treated with CAPE showed a lower level of TNF-α compared to the negative control. More interestingly, the one-way ANOVA data demonstrated a decreased level of proinflammatory IL-6 in the CAPE-treated group compared to the negative control.Conclusion: Results of this study indicate that short-term administration of CAPE may modulate proinflammatory cytokine profiles during moderate exercise and may serve to boost the anti-inflammatory effects of exercise. Further studies are needed to evaluate the efficacy and safety of long-term administration of CAPE as an adjective anti-inflammatory agent.Keywords: CAPE, swimming, rats, interleukins, proinflammatory

Ahmed Hussein Subki,1 Abdullah Khaled Agabawi,2 Muhab Mohammed Hindi,2 Nadeem Shafique Butt,3 Mohammed Saad Alsallum,4 Rawan Ali Alghamdi,2 Siham Hussein Subki,2 Fahad Alsallum,2 Abdulaziz Ahmed Alharbi,5 Yousif Ibrahim Lodhi,6 Sultan Alandijani,1 Faten Al-Zaben,7 Harold G Koenig,7,8 Ayman M Oraif2 1Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 2Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Biostatistics, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 5‏Department of Emergency Medicine, King Fahad General Hospital, Jeddah, Saudi Arabia; 6Department of Internal Medicine, East Jeddah Hospital, Jeddah, Saudi Arabia; 7Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USACorrespondence: Ayman M OraifDepartment of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi ArabiaTel +966 53 806 2000Email ayman_oraif@yahoo.comBackground: The patient–doctor relationship is one of the most important factors in determining the outcome of healthcare. The first step in establishing this relationship is choosing a physician. This study sought to identify patient preferences concerning the gender of their obstetrics and gynecology (OB-GYN) physician and the effect of religion and society on these choices.Methods: A cross-sectional study was conducted at the OB-GYN outpatient clinics at King Abdulaziz University Hospital in Jeddah between February 2017 and June 2017. A total of 227 female patients were recruited. Eligible were women ages 18 years or older who had attended the clinic at least three times. A 30-item questionnaire was administered.Results: Significantly, more female doctors were preferred for pelvic examination in lower income group (p=0.003), while male doctors were preferred for surgery (p=0.010) in higher income group. Significantly more male doctors were preferred for pelvic examination and gynecological surgery in > 35-year age group (p=0.015 and p=0.017, respectively). With regard to predictors, embarrassment was the most significant factor reported for not choosing a male obstetrician/gynecologist (OB-GYN) in the younger age group. Nearly three-quarters (71.2%) of respondents with age ≤ 35 reported embarrassment as a factor for not choosing a male OB-GYN; 79.7% of this subgroup indicated that female doctors were more knowledgeable about women’s health issues.Conclusion: Participants expressed a strong preference for female providers overall, although some women preferred male providers during certain circumstances (gynecologic surgery). Despite these gender preferences, more important to women in their choice of OB-GYN provider was the doctor’s experience, qualifications, and reputation. Such trends are consistent with those culturally similar countries and in line with trends worldwide. These findings have the potential to significantly impact the personal health for women in Saudi Arabia and elsewhere in the Middle East where religious and cultural traditions are so important in decision-making.Keywords: gender, preference, obstetrics, gynecologist, patient care

Let ℋ{\mathcal{ {\mathcal H} }} be a complex Hilbert space and ℬ(ℋ){\mathcal{ {\mathcal B} }}\left({\mathcal{ {\mathcal H} }}) denotes the algebra of all bounded linear operators acting on ℋ{\mathcal{ {\mathcal H} }}. In this paper, we present some new pairs of generalized finite operators. More precisely, new pairs of operators (A,B)∈ℬ(ℋ)×ℬ(ℋ)\left(A,B)\in {\mathcal{ {\mathcal B} }}\left({\mathcal{ {\mathcal H} }})\times {\mathcal{ {\mathcal B} }}\left({\mathcal{ {\mathcal H} }}) satisfying: ∥AX−XB−I∥≥1,for allX∈ℬ(ℋ).\parallel AX-XB-I\parallel \ge 1,\hspace{1.0em}\hspace{0.1em}\text{for all}\hspace{0.1em}\hspace{0.33em}X\in {\mathcal{ {\mathcal B} }}\left({\mathcal{ {\mathcal H} }}). An example under which the class of such operators is not invariant under similarity orbit is given. Range kernel orthogonality of generalized derivation is also studied.

Ayad Mohammed Salem,1 Noor Al Khathlan,2 Abdulelah Fawzi Alharbi,3 Turki Alghamdi,3 Saleh AlDuilej,3 Mohammed Alghamdi,3 Majed Alfudhaili,3 Ahmed Alsunni,1 Talay Yar,1 Rabia Latif,1 Nazish Rafique,1 Lubna Al Asoom,1 Hussein Sabit4 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of respiratory care, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Genetics, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Ayad Mohammed SalemDepartment of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, PO Box 2114, Dammam, 31451, Saudi ArabiaEmail ayadsalem@iau.edu.saBackground: The sequelae of COVID-19 pneumonia on pulmonary function and airways inflammation are still an area of active research.Objective: This research aimed to explore the long-term impact of COVID-19 pneumonia on the lung function after three months from recovery.Methods: Fifty subjects (age 18– 60 years) were recruited and classified into two groups: the control group (30 subjects) and the post-COVID-19 pneumonia group (20 patients). Pulmonary function tests, spirometry, body plethysmography [lung volumes and airway resistance (Raw)], diffusion capacity for carbon monoxide (DLCO), and fractional exhaled nitric oxide (FeNO), were measured after at least 3 months post-recovery.Results: Significant reduction in total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FEV, and diffusing capacity for carbon monoxide (DLCO) was observed in post-COVID-19 subjects compared to controls. Restrictive lung impairment was observed in 50% of post-COVID-19 cases (n = 10) compared to 20% in the control group (n = 6, P = 0.026). In addition, mild diffusion defect was detected in 35% (n = 7) of the post-COVID-19 group compared to 23.3% (n = 7) in the controls (P = 0.012).Conclusion: COVID-19 pneumonia has an impact on the lung functions in terms of restrictive lung impairment and mild diffusion defect after three months from recovery. Therefore, a long-term follow-up of the lung function in post-COVID-19 survivors is recommended.Keywords: COVID-19, pneumonia, PFT, DLCO, FeNO

Esam Dhaifullah,1 Hassan S Seayed,1 Diana Mostafa,1,2 Abdul Majeed M Alharbi,1 Waleed M Alotaibi1 1Department of Preventive Dental Sciences, Vision Colleges, Riyadh, Kingdom of Saudi Arabia; 2Clinical Periodontology Department, Faculty of Dentistry, Alexandria University, Alexandria, EgyptCorrespondence: Diana MostafaClinical Periodontology Department, Faculty of Dentistry, Alexandria University, Alexandria, EgyptEmail dr.dianamostafa@gmail.comBackground: Recently, pharmacologic approaches have been seen in utilizing matrix metalloproteinase inhibitors (MMP-I) to prohibit the destruction of connective tissue accompanied by erythrogenic inflammatory diseases such as periodontitis. However, curcumin characteristics have been described to be effective in reducing inflammatory mediators and matrix metalloproteinase (MMP). But, due to its poor solubility and bioavailability, a chemically modified curcumin (CMC 2.24) has been used.Objective: The purpose of this research is to review and analyze the animal attempts which investigate the impact of CMC2.24 on periodontitis.Materials and Methods: Our study was based on reviewing the English preclinical studies using CMC2.24 on an induced periodontal disease which were published up to 2020, only randomized control trials (RCTs) were included. Databases were used from electronic websites including PubMed, ScienceDirect, and Google scholar.Results: Seven experimental trials involving 162 rats and 8 dogs were included in the present systematic review. Six studies investigated LPS-induced experimental periodontitis, two of them worked on diabetes-associated periodontitis, while one study worked on naturally occurring periodontitis. All included studies revealed that CMC 2.24 reduced alveolar bone loss as well as inhibited the MMP.Conclusion: Collectively, we concluded that CMC 2.24 has significant implications in prohibiting the progression of bone loss.Keywords: chemically modified curcumin, matrix metalloproteinase, cytokines, periodontitis, CMC2.24

Adel Alsantali,1 Basel Almalki,2 Abdullah Alharbi3 1Department of Dermatology, Hair Disorder Unit, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia; 2Department of Dermatology, King Abdulaziz Medical City, Ministry of National Guard, Jeddah, Saudi Arabia; 3Department of Pathology, King Fahad Armed Forces Hospital, Jeddah, Saudi ArabiaCorrespondence: Adel AlsantaliDepartment of Dermatology, Hair Disorder Unit, King Fahad Armed Forces Hospital, P.O. Box 53893, Jeddah, 21593, Saudi ArabiaEmail santli26@hotmail.comAbstract: Dissecting cellulitis (DC) of the scalp or perifolliculitis capitis abscedens et suffodiens is a rare chronic inflammatory condition of the scalp manifested by perifollicular pustules, nodules, abscesses and sinuses that result into scarring alopecia. Treatment of DC is challenging and often disappointing. We report a 38-year-old male patient with DC for 5 years, and multiple topical and systemic therapies had shown poor effect. This patient achieved excellent response to adalimumab with hair regrowth.Keywords: dissecting cellulitis, perifolliculitis capitis abscedens et suffodiens, adalimumab, TNF-α inhibitor

Saleh A Alharbi, 1, 2 Sumayyah AN Kobeisy, 1 Suzan A AlKhater, 3, 4 Adel S Alharbi, 3– 5 Mansour M Alqwaiee, 3– 5 Faisal N Alotaibi, 3– 5 Khalid A Alawam, 3– 6 Turki S Alahmadi, 3– 7 Faisal M Al-Somali, 8 Talal M Almaghamsi, 3– 7, 9 Abdullah A Yousef 3, 4 1Department of Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 2Department of Pediatrics, Umm Al-Qura University, Mecca, Saudi Arabia; 3Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Pediatrics, King Fahd Hospital of the University, AlKhobar, Saudi Arabia; 5Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 6Inaya Medical College, Riyadh, Saudi Arabia; 7Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 8Department of Pediatrics, Sulaiman Al Habib Hospital, Al Khobar, Saudi Arabia; 9Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi ArabiaCorrespondence: Saleh A AlharbiDepartment of Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi ArabiaEmail salharbi@fakeeh.careBackground: Bronchial asthma is a chronic inflammatory airway disease that is characterized by reversible airway obstruction due to bronchial hyperresponsiveness. It is one of the most common chronic diseases. In Saudi Arabia, asthma affects 2 million people with asthma frequency in children markedly higher than adults with regional variations ranging from 9% to 33.7%.Objective: The aim of this study is to measure asthma awareness and knowledge of study participants during the ongoing annual Saudi asthma awareness campaigns and compare them with previous survey data conducted in 2014.Methods: A cross-sectional study was carried out in the form of a survey distributed across three major cities in Saudi Arabia, Jeddah, Riyadh and Dammam, during the National Asthma Awareness Campaign in major regional shopping centers in April 2019. Asthma knowledge scores across different demographic groups were generated from surveyed data. Descriptive and correlative statistical analyses were performed to identify factors associated with changes in asthma knowledge. Scores were compared to previous survey results.Results: The mean score for asthma knowledge was 15.6 out of 25. Asthma knowledge significantly correlated with age (P=0.002), asthma status of the participants (P=0.001), having children with asthma (P=0.005) or knowing friends or family with asthma (P=0.029) but not with other socioeconomic factors such as gender, marital status, occupation, level of education and number of children in the family (P > 0.05). There was a significant difference in the asthma scores from 2014 (M= 63%, SD=26) to 2019 (M= 70%, SD= 26) conditions; t (24) = − 2.106, p=0.046.Conclusion: Further educational campaigns are necessary to enhance and measure general public awareness of asthma, its differential diagnosis against other respiratory infections, environmental triggers, risk factors as well as treatment options.Keywords: asthma, awareness, pediatrics, Saudi Arabia

This article investigated teachers' self-efficacy, educational practices, challenges and support for students with disabilities in the inclusive classroom. Students with disabilities face many adversities today, such as rejection, stigma, discrimination and lack of support in the classroom. We employed an interdisciplinary and pluralistic approach (Baglieri et al., 2011; Connor et al., 2011) embedded in disability studies in education (DSE) and self-efficacy theory to explore in-service teachers' experiences in the field of inclusive education. We used a phenomenological approach and conducted eight teachers' semi-structured interviews and classroom observations. We used purposeful sampling among teachers who work with students with disabilities. We used inductive analysis techniques to analyse the qualitative data collected from interviews and classroom observations. This study's findings reveal the importance of teachers' preparation, attitude and self-efficacy to support students with disabilities in inclusive classrooms; the use of differentiated instruction strategies to meet the student's needs and increase their academic outcomes; and highlight the challenges, which include the lack of professional development, lack collaboration among teachers lack of parents' communication and lack of regular IEP meeting.

An experiment was performed at GSI with the objective of measuring theβ-intensity distribution in the decay of Hg, Au and Pt isotopes around N=126 using the total absorption gamma-ray spectroscopy technique. The aim is to benchmark theoretical models used to make predictions of half-life and neutron emission probabilities of exotic nuclei involved in the rapid neutron capture process, leading to the synthesis of very heavy elements. This paper presents some experimental details and the current status of the analysis.

Yasser Alatawi,1 Fahad S Alshehri,2 Abdullah A Alhifany,3 Adnan Alharbi,3 Badrah S Alghamdi4 1Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia; 2Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 3Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 4Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Fahad S AlshehriDepartment of Pharmacology and Toxicology, College of Pharmacy, Umm Al‑Qura University, Al‑Abidiyya, Makkah 21955, Kingdom of Saudi ArabiaTel +966 542166571Email fsshehri@uqu.edu.saPurpose: This study aimed to investigate the prevalence of and factors associated with posttraumatic stress disorder (PTSD) during the COVID-19 pandemic in Saudi Arabia.Materials and Methods: This was a cross-sectional online survey that targeted adults over the age of 18 residing in Saudi Arabia. The data collection began June 1, 2020 and continued for four weeks. The Posttraumatic Stress Disorder Checklist-Specific, the Brief Illness Perception Questionnaire version BIP-Q5, and a 9-item health literacy measure were used.Results: There were 1249 participants, of which 62.21% were under the age of 34. The prevalence of PTSD was 19.5% among all participants. The results showed that both the perception of threat (OR =1.17, 95% CI = 1.13− 1.19) and health literacy (OR =0.97, 95% CI = 0.95− 0.99) were associated with PTSD symptoms.Conclusion: This study highlights important findings that the level of an individual’s perception of threat and health literacy is associated with symptoms of PTSD. Thus, an understanding of these constructs in the target population will enable the development of better measures designed to reduce the psychological impact of the COVID-19 pandemic.Keywords: COVID-19, Saudi Arabia, posttraumatic stress disorder, perception, health literacy

Hani Alnajjar,1 Rawan Mostafa Hilal,2 Arwa Jabir Alharbi,2 Omimah Hasan Alharthi,2 Raghad Ateeg Batwie,2 Raghad Mohammed AlShehri,2 Mohammed R Algethami3 1Department of Anesthesia, University of Jeddah, Jeddah, Saudi Arabia; 2Medical College, King Abdulaziz University, Jeddah, Saudi Arabia; 3Preventive Medicine Resident, Joint Program, Ministry of Health, Jeddah, Saudi ArabiaCorrespondence: Rawan Mostafa HilalMedical School, King Abdulaziz University, P.O.Box: 3575, Alsharqiah 32654, Jeddah, Saudi ArabiaTel +966599888471Email rawanhilal.1418@gmail.comBackground: Cardiac arrests are a leading cause of mortality in Saudi Arabia. Prompt and quick intervention using early cardiopulmonary resuscitation (CPR) can be a life-saving strategy. Sufficient knowledge and awareness regarding CPR are important in initial care, particularly during an out-of-hospital cardiac arrest. We aim to assess the knowledge, awareness, and attitude toward CPR among the students of King Abdulaziz University and Jeddah University.Materials and Methods: A descriptive, cross-sectional study design with a sample of 1053 non-medical students, regardless of their academic year, was conducted from May to July 2019 at both universities. Data were analyzed through chi-square and analysis of variance where a P-value < 0.05 was considered statistically significant.Results: Out of 1053 students, 28.7% received CPR training. Also, the majority of the subjects were female 71%. The science department provided the largest response. Results showed that chest pain was the most observed early sign of cardiac arrest among participants by a percentage of 84.6. Majority of the participants (90.9%) felt no hesitation in performing early CPR on a family member. Additionally, committing a mistake was the most feared factor that deterred students from performing CPR.Conclusion: Knowledge and awareness of CPR among non-medical university students were poor, despite positive attitudes toward it. Integrating mandatory CPR courses in the orientation and in the first year of the undergraduate curriculum could increase awareness and improve the outcomes of out-of-hospital cardiac arrest (OHCA).Keywords: basic life support, cardiopulmonary resuscitation, cardiopulmonary resuscitation training, out-of-hospital cardiac arrest, cardiac arrest

Kaposi Sarcoma (KS) is most commonly associated with Acquired Immunodeficiency Syndrome (AIDS). Kaposi sarcoma herpesvirus is thought to play a huge role in the pathogenesis of KS. The diagnosis and management of KS can be quite challenging, and Physicians need high index of suspicion to diagnose KS as it can be mistaken for other skin pathologies. We present a case of a young male who developed KS on the penis as the initial manifestation of human immunodeficiency virus infection (HIV) and AIDS. Initially, he presented with a painful non-resolving ulcer on the glans penis for 2 weeks. He tested positive for HIV and his HIV viral load was more than 200,000 copies with CD4 count being only 8 per microliter. Histopathological examination of the lesion along with immunohistological staining were positive for KS. The patient was not adherent to his antiretroviral therapy (ART), and his condition deteriorated. Literature review showed only 16 cases of HIV positive patients presenting with KS involving the penile area, with only 4 of them being the initial manifestation of HIV and AIDS. A combination of systemic chemotherapy and ART is often needed for visceral or metastatic KS. There is a huge need to increase awareness about HIV and related complications among health care providers and the general population.

Ebrahim Mahmoud,1 Sarah Al Mansour,1 Mohammad Bosaeed,1– 3 Ahmad Alharbi,1 Abdulrahman Alsaedy,1,2 Sameera Aljohani,2,4 Bassam Alalwan,4 Adel Alothman1,2, † 1Division of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia; 2College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; 4Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City - Riyadh, Riyadh, Saudi Arabia†Doctor Adel Al Othman passed away on June 8, 2020Correspondence: Ebrahim MahmoudDivision of Infectious Diseases, Department of Medicine, King Abdulaziz Medical City - Riyadh, P.O. Box 22490, Riyadh 11426, Saudi ArabiaTel +966 500081418Email emahmoud85@gmail.comAbstract: While methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has poor outcomes, we describe our experience with Ceftobiprole mainly as a combination therapy for the treatment of MRSA bacteremia. All the cases of MRSA bacteremia in our center at the King Abdulaziz Medical City (KAMC), Riyadh, that had undergone Ceftobiprole treatment were included. We had six cases of MRSA bacteremia between 2018 and 2019, secondary to different infectious syndromes including endocarditis. There was a severe infection that required intensive care unit (ICU) admission in four cases. Ceftobiprole is used in combination with vancomycin in four cases. On day 14, all cases had a favorable outcome with microbiological and clinical improvement. However, three patients died after months of suffering from bacteremia from unrelated causes for the infection. The clinical outcome in our series of treatment of MRSA bacteremia using Ceftobiprole was favorable. Further studies for the evaluation of the use of Ceftobiprole in MRSA bacteremia should be encouraged.Keywords: methicillin-resistant Staphylococcus aureus, bacteremia, Ceftobiprole, treatment

Abdullah Albassam,1 Amal Alharbi,2 Ahmed Awaisu3 1Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait; 2Department of Pharmacy, Farwaniya Hospital, Ministry of Health, Kuwait City, Kuwait; 3Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, QatarCorrespondence: Abdullah Albassam Email albassam@hsc.edu.kwPurpose: Inhaled corticosteroids (ICS) are the mainstay maintenance therapy for asthma management. Non-adherence to ICS, which can lead to exacerbations and poor asthma control, is commonly reported among adult patients with asthma. The level of adherence to ICS among adult patients with asthma in Kuwait has not been previously published. The aim of this study was to assess adherence to ICS among adults with asthma in Kuwait.Patients and Methods: A cross-sectional study was conducted among adult patients with asthma using ICS therapy at ambulatory asthma clinics in Kuwait. Adherence to ICS was assessed using the Medication Adherence Report Scale for Asthma (MARS-A). Descriptive and logistic regression analyses were conducted using SPSS version 23.Results: One hundred and forty-nine patients with a mean age of 41.42 (12.75) years participated in the study. The majority of the participants (82.6%) reported low adherence to ICS. Approximately, three-quarters of the participants reported that they used ICS either when needed or when they felt breathless. Furthermore, about half of them admitted that they tried to avoid using ICS (46.3%), or forgot to take ICS (51%), or only used ICS before performing an exercise that made them breathless (54%). In the multivariate logistic regression analysis, independent predictors (age, education, and smoking status) were not found to significantly influence the overall adherence to ICS therapy.Conclusion: Adherence to ICS among adult patients with asthma was found to be low in ambulatory care settings in Kuwait. Future studies should aim to determine the barriers to ICS adherence among patients with asthma, with a focus on developing effective intervention strategies.Keywords: adherence, asthma, Kuwait, inhaled corticosteroid, medication adherence report scale

Hisham Arab,1 Ahmed Jaber Alharbi,2 Ayman Oraif,3 Emad Sagr,4 Hana Al Madani,5 Hassan Abduljabbar,3 Osama Sadeak Bajouh,3 Yaser Faden,6 Yasser Sabr7 1Obstetrics and Gynecology Department, Dr. Arab Medical Center, Jeddah, Saudi Arabia; 2Obstetrics and Gynecology Department, Ibinsina Medical Private College, Jeddah, Saudi Arabia; 3Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia; 4Obstetrics and Gynecology Department, The International Medical Center, Jeddah, Saudi Arabia; 5Obstetrics and Gynecology Department, Maternity Hospital – King Saud Medical City, Riyadh, Saudi Arabia; 6Department of Obstetrics and Gynecology, King Saud bin Abdulaziz University for Health Sciences – Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia; 7Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Khalid University Hospital, Riyadh, Saudi ArabiaCorrespondence: Hisham ArabObstetrics and Gynecology Department, Dr. Arab Medical Center, P.O. Box 17440, Jeddah 21484, Saudi ArabiaTel +966 12 2832111Email arab123@gmail.comAbstract: It is well known that progesterone plays a major role in the maintenance of pregnancy, particularly during the early stages, as it is responsible for preparing the endometrium for implantation and maintenance of the gestational sac. The management of pregnant women at risk of a threatened or idiopathic recurrent miscarriage is complex and critical. Therefore, a group of obstetricians and gynecologists practicing in Saudi Arabia gathered to update the 2014 Saudi guidelines for threatened and recurrent miscarriage management. In preparation, a literature review was conducted to explore the role of oral, vaginal, and injectable progestogens: this was used as a basis to develop position statements to guide and standardize practice across Saudi Arabia.Keywords: idiopathic recurrent miscarriage, progesterone, progestin, progestogen, Saudi Arabia, threatened miscarriage

Based on a sociocultural theory and a plethora of experiential studies on the efficacy of scaffolding on foreign language learning, the goal of this research article is to examine the effectiveness of diverse types of scaffolding on university students' lexical digesting and reading perception from a sociocultural standpoint. Using the Harvard Placement Test, 40 EFL students from a total of 70 were selected and divided into two experimental groups and a single control group. The first group (G1 Exp.) was given teaching with instructor scaffolding, the second group (G2 Exp.) received instruction with peer scaffolding, and the control group (G3 Cont.) received conventional instruction without any external enhancement. Pretests for lexical digesting and reading perception were administered to the three groups. Following the treatment, post-tests for lexical digesting and reading perception were administered. Descriptive statistics and inferential statistics were used to examine the collected data. The results showed a significant difference between instructor and peer scaffolding, with the peer scaffolding group outperforming the instructor scaffolding group. Both experimental groups outperformed the control group in lexical digesting and reading perception. Regarding various kinds of scaffolding, this study provided some advice for psycholinguists, curriculum designers, and language instructors.