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Ayodele Alaiya,1 Abeer Alshukairi,2 Zakia Shinwari,1 Mariam AL-Fares,3 Jawaher Alotaibi,4 Waleed AlOmaim,3 Ibtihaj Alsharif,5 Razan Bakheet,6 Layla Alharbi,5 Rabab Allam,1 Ayed Asiri,7 Ziad Memish,8 Khaldoun Alromaih,6 Maha Al-Mozaini5 1Proteomics Unit, Stem Cell and Tissue Re-Engineering Program, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia; 2Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia; 3Clinical Chemistry Laboratory, Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 4Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia; 5Immunocompromised Host Research Unit, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; 6Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia; 7Critical Care Services, Al Imam Abdulrahman Al Faisal Hospital, Riyadh, Kingdom of Saudi Arabia; 8Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Ayodele AlaiyaProteomics Unit, Stem Cell and Tissue Re-Engineering Program, King Faisal Specialist Hospital and Research Centre, KFSH&RC, BOX 3354, Riyadh, 11211, Saudi ArabiaTel +966 114424178Email aalaiya@kfshrc.edu.saMaha Al-MozainiImmunocompromised Host Research Unit, Department of Infection and Immunity, KFSH&RC, Riyadh, Saudi ArabiaTel +966 114439632Email mmozaini@kfshrc.edu.saPurpose: This study aimed to understand the pathophysiology of host responses to infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/(COVID-19) and Middle East respiratory syndrome coronavirus (MERS-CoV) and to identify proteins for patient stratification with different grades of illness severity.Patients and Methods: Peripheral blood samples from 43 patients with different grades of COVID-19, 7 MERS-CoV patients admitted to the ICU, and 10 healthy subjects were analyzed using label-free quantitative liquid chromatography–mass spectrometry (LC–MS).Results: We identified 193 and 91 proteins that differed significantly between COVID-19 and MERS-CoV sample groups, respectively, and 49 overlapped between datasets. Only 10 proteins are diagnostic of asymptomatic cases, 12 are prognostic of recovery from severe illness, and 28 are prognostic of a fatal outcome of COVID-19. These proteins are implicated in virus-specific/related signaling networks. Notable among the top canonical pathways are humoral immunity, inflammation, acute-phase response signaling, liver X receptor/retinoid X receptor (LXR/RXR) activation, coagulation, and the complement system. Furthermore, we confirmed positive viral shedding in 11.76% of 51 additional peripheral blood samples, indicating that caution should be taken to avoid the possible risk of transfusion of infected blood products.Conclusion: We identified COVID-19 and MERS-CoV protein panels that have potential as biomarkers and might assist in the prognosis of SARS-CoV-2 infection. The identified markers further our understanding of COVID-19 disease pathophysiology and may have prognostic or therapeutic potential in predicting or managing host cell responses to human COVID-19 and MERS-CoV infections.Keywords: COVID-19, SARS-CoV, MERS-CoV, expression proteomics, biomarkers

Laila A Alharbi,1 Mohamed Cheikh,2 Manal E Alotaibi,1 Amal A Alkhotani,1 Hussam M Alim,1 Fahd Almalki,1 Mohammed S Samannodi,1 Hadeel A Khadawardi,1 Ahmad A Imam,1 Yosra A Turkistani,1 Fozya B Bashal,1 Abdullah Tawakul,1 Adeeb A Bulkhi,1 Mohammad S Dairi,1 Rania Zaini,3 Hani M Almoallim1 1Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia; 2Department of Medicine, Al Salama Hospital, Jeddah, Saudi Arabia; 3Department of Community Medicine, Umm Al-Qura University (UQU), Makkah, Saudi ArabiaCorrespondence: Hani M Almoallim, Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia, Email hmmoalim@uqu.edu.saBackground: Entrustable professional activities (EPAs) define the core tasks that a graduating rheumatologist needs to perform independently in practice. The objective of this study was to develop and validate EPAs for rheumatology fellowship training programs in Saudi Arabia.Methods: Experts met to develop an initial set of potential end-of-training EPAs by conducting a comprehensive literature review of EPAs and studying the Saudi rheumatology fellowship curriculum. Then, to validate the EPAs, we conducted two rounds of the modified Delphi technique among rheumatology experts in Saudi Arabia. A response rate of 80% was considered and the minimum number of experts needed to be 25 to 30. Descriptive statistics were utilized to describe participants’ demographic characteristics and group responses to each statement in all rounds. The experts were asked to rate the relevancy of each EPA using a 5-point Likert scale in both Delphi rounds.Results: In the preliminary phase, four rheumatologists developed an initial set of 36 core EPAs for rheumatology training program in Saudi Arabia. For the two-rounds Delphi techniques, 32 experts were invited to complete the study. The response rate of the first and second round were, 78.12% (25) and 93.75% (30), respectively. The first-round Delphi resulted in a robust consensus on 31 EPAs for rheumatology training. Five EPAs were excluded, and one new EPA was proposed. In the subsequent round, all 32 EPAs achieved strong consensus. The eliminated EPAs likely fell short in one or more of the following areas: relevance to rheumatology practice in Saudi Arabia, overlapping with other EPAs, or practical challenges in the implementation.Conclusion: We have developed and validated a core set of EPAs for rheumatology fellowship training programs in Saudi Arabia. Mapping and identifying milestones for these EPAs are essential steps to follow to enhance workplace curriculum development.Keywords: entrustable professional activities, EPAs, rheumatology, training programs, fellowship, Saudi Arabia, curriculum, workplace

Heat transfer (HT) technology is rapidly increasing due to the petition for well-organized heating systems and cooling systems in the requisite posited by chemical, automotive, and aerospace industries. Thus, the present investigation examines mixed convective or buoyancy flow induced by the Williamson fluid closer to the stagnation point worsened by hybrid nanoparticles (alumina [Al2O3] and copper [Cu]) through a flat upright plate by the influence of the Hall effect. The water-based Al2O3 and copper Cu nanoparticles acknowledging convectively-heated as suitable in the industry or engineering are inspected. The dominant equations are non-dimensionalized using the appropriate similarity parameters, and subsequently, using the bvp4c, these are solved numerically. We thoroughly investigate the effects of numerous pertinent parameters on the transverse velocity, the axial velocity, drag force, temperature, and HT. Two dissimilar outputs are perceived in the circumstance of opposing flow, compared to simply one in the assisting flow. The solutions also showed that the thermal boundary layer length increases and the velocity thickness of the boundary layer decreases as a result of the nanofluid. The higher Weissenberg number causes the gradients for the stable result branch to increase, whereas the gradients for the lower result branch drop. The Lorentz force impact can also be utilized to modify the flow and physical characteristics of HT. In addition, the friction factor in the transverse axis enlarges with the magnetic number for both branches.

Electronic cigarettes, frequently referred to as e-cigarettes, have emerged as a controversial and rapidly growing phenomenon in the realm of tobacco and nicotine consumption worldwide. This study reports the prevalence of respiratory symptoms among e-cigarette users. This study also helps to understand the potential harmful effects and importance of quitting e-cigarette smoking. An observational cross-sectional study was carried out in Saudi Arabia. The study period was from September 2022 to August 2023. The sample size was 447 participants. Among recent e-cigarette users in this Saudi study, usage varied, with 44.1% using 1–5 days, 33.6% using 6–30 days, and 22.4% using e-cigarettes previously but not in the previous month. Vape devices were predominant (42.7%). There were significant associations emerged between e-cigarette use frequency and symptoms such as fatigue, breathlessness, and shortness of breath. E-cigarette use was notably linked to asthma-related symptoms, underscoring its concerning impact on respiratory health (P < 0.05). E-cigarette consumption has a significant impact on respiratory effects and specifically asthma-related symptoms among this Saudi population.

Abdullah Alshammari,1 Basmah Ahmed Qasem,1 Nouf Ahmed Almatrafi,1 Lujain Mofareh Alharbi,1 Abeer Abdulhadi Alhuthali Snr,2 Attiah Abdulrahman Khobrani,2 Mohammed Alnuhait1 1Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia; 2Clinical Pharmacy Department, King Abdullah Medical City, Makkah, Saudi ArabiaCorrespondence: Mohammed Alnuhait, Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia, Email manuhait@uqu.edu.saBackground: Chemotherapy-induced cardiotoxicity is a significant problem, ranking as the second most frequent cause of mortality in cancer patients. This adverse outcome encompasses many cardiovascular problems, such as heart failure. Sacubitril/valsartan has shown potential in the management of heart failure, however, its effectiveness in treating chemotherapy-induced heart failure has not been extensively explored. We performed a case series to investigate the safety and effectiveness of sacubitril/valsartan in treating chemotherapy-induced cardiomyopathy in Saudi Arabia.Methods: The case series was conducted at a single medical center in Makkah, Saudi Arabia. The data gathered included patient demographics, clinical features, laboratory results, echocardiographic findings, and medication information. The data underwent analysis using descriptive statistics.Results: Out of the total of eight patients who were part of the investigation, a notable majority of six individuals exhibited substantial enhancements in their ejection fraction (EF) after receiving sacubitril/valsartan medication.Conclusion: Our case series provides significant insights by revealing improvements in ejection fraction (EF) in six out of eight patients who had chemotherapy-induced cardiomyopathy after receiving sacubitril/valsartan treatment.Keywords: oncology, sacubitril/valsartan, cardiotoxicity, chemotherapy, Saudi Arabia

Mishal F Karremah,1 Rola Y Hassan,2,3 Ammar Z Faloudah,1 Lujain K Alharbi,4 Albraa F Shodari,1 Ahmad A Rahbeeni,1 Nouf K Alharazi,1 Ahmad Z Binjabi,1 Mohamed M Cheikh,3,5 Hanadi Manasfi,6 Sultana Abdulaziz,7 Albadr Hamza Hussein,4 Ahmed Alhazmi,2 Hani Almoallim1,3,8 1Department of Medicine, College of Medicine, Umm Alqura University, Makkah, Saudi Arabia; 2Department of Medicine, Division of Rheumatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia; 3Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia; 4Department of Medicine, Division of Rheumatology, King Fahad Hospital, Madinah, Saudi Arabia; 5Department of Medicine, College of Medicine, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia; 6Department of Medicine, Specialized Medical Center, Riyadh, Saudi Arabia; 7Department of Medicine, King Fahad General Hospital, Jeddah, Saudi Arabia; 8Department of Medicine, Dr. Sameer Abbas Hospital, Jeddah, Saudi ArabiaCorrespondence: Hani Almoallim, Tel +966505703935, Email Hmmoallim@uqu.edu.saBackground and Objectives: Early diagnosis and treatment is associated with improved outcomes in patients with systemic lupus erythematosus (SLE). Studying the journey of SLE patients in Saudi Arabia is essential to direct future health-care plans.Patients and Methods: This is a cross-sectional, multicenter study. Eligibility criteria included a diagnosis of SLE that was confirmed by a rheumatologist. Patients younger than 18 at the time of interview were excluded. Primary objectives were to determine time from first symptoms to initial physician visit (Lag 1), time from initial physician visit to encounter with rheumatologist (Lag 2), time from first visit to a rheumatologist to diagnosis of SLE (Lag 3), and time from diagnosis to start of treatment (Lag 4). Secondary objectives were to determine the number and specialty of physicians seen by patients, the speciality type that confirmed the diagnosis, first symptoms experienced, and age at first diagnosis of SLE.Results: Three hundred patients (92.3% women) with SLE were evaluated. Mean age at diagnosis was 29.92 years. Mean disease duration was 8.1 years. The majority were college educated (43.0%). The most common initial symptom was joint pain (68%), followed by skin rash (23%), and fever (3.7%). Lag 1 was less than one month in 68.2% of patients. Lag 2 was less than one month in 33.4% of patients and exceeded one year in 25.8%. Lag 3 was less than 1 month in 68.7% of patients. Lag 4 was less than one month in 94.4% of patients. The diagnosis of SLE was made most frequently by rheumatologists (80%). Evaluation by primary care, orthopedic and dermatology physicians were associated with delays in diagnosis.Conclusion: Delay was marked in Lag 2. Causes of delay included evaluation by non-specialists and visiting higher numbers of physicians before diagnosis confirmation.Keywords: systemic lupus erythematosus, rheumatology, delay, Saudi Arabia, physician

Introduction: Clinical trials are crucial for advancing medical knowledge and improving healthcare outcomes. Despite an increase in research publications in Saudi Arabia, clinical trial productivity has lagged behind. Understanding the barriers to conducting clinical trials in Saudi Arabia is essential. This study aims to explore the challenges and propose solutions for improving clinical trial capacity in the Kingdom. Specifically, we aim to develop national strategies to enhance clinical trial infrastructure, identify educational needs, and suggest ways to strengthen research education and training in Saudi Arabia., Methods: The study utilized a qualitative research design with a grounded theory approach. Participants were recruited through purposive sampling, including clinical trial professionals from Riyadh, Jeddah, and Al Khobar, who participated in three half-day workshops. Discussions focused on required skillsets, barriers to conducting trials, improvement recommendations, gaps in research education, and strategies for the Saudi National Institute of Health (SNIH) to support clinical trials. Data were collected through pre-workshop surveys and focus group discussions, and thematic analysis was employed to identify common themes., Results: A total of 35 participants, mainly from the government sector (67%), attended the workshops. Physicians represented the largest professional group (31%), with the majority being Saudi nationals (83%) and engaged in clinical practice (65%). The study identified key challenges, including limited resources (82%), inadequate infrastructure (82%), time constraints (80%), and insufficient funding (80%). While satisfaction with educational programs was mixed, a need for improved infrastructure and support for clinical trials in Saudi Arabia was evident. The focus group discussions further highlighted the importance of research competency, identifying 11 essential domains such as research methodology, data management, and project leadership. Nine major challenges were noted, including funding, infrastructure, and collaboration deficits. A total of 38 recommendations were proposed to address these challenges and enhance the national clinical trial ecosystem., Conclusions: This study underscores the importance of addressing the challenges in conducting clinical trials in Saudi Arabia through targeted educational programs, training initiatives, and enhanced support from the SNIH. By implementing strategies that focus on funding, resources, training, and collaboration, Saudi Arabia can significantly advance its clinical trial landscape, improve research quality and efficiency, and position itself as a leader in global health research.

Background: Globally, sexually transmitted infections (STIs) collectively cause 2.3 million deaths and 1.2 million cases of cancer annually. However, the epidemiology of STIs in the Middle East and North Africa (MENA) is not well assessed because of various social and cultural factors., Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and covering 23 MENA countries, 19 STIs, and data from 20,435,971 participants. PubMed, Embase, regional and international databases, and country-level reports were searched up to May 2024., Results: The analysis revealed significant regional variations in the prevalence of STIs within the MENA region. In North Africa, the most common STIs were bacterial vaginosis (31%), human papillomavirus (HPV, 23%), and Candida spp. (15%). In the Gulf Cooperation Council region and Yemen, Ureaplasma (25%), nongonococcal urethritis (NGU, 16%), and Mycoplasma spp. (12%) were the predominant infections. In the Levant region, the top STIs were HPV (20%), hepatitis B virus (HBV, 9%), and Candida spp. (9%). In Iran, Ureaplasma spp. (18%), HPV (17%), and cytomegalovirus (8%) were the most prevalent infections, whereas Ureaplasma spp. (20%), Candida spp. (18%), and HPV (16%) were most frequently detected in Türkiye. Gender-based disparities were observed, with a higher prevalence of Ureaplasma spp., Neisseria gonorrhoeae, and herpes in men and higher rates of Mycoplasma spp., HPV, HBV, and Candida spp. in women. Overall, high rates of nongonococcal urethritis (16.3%), Ureaplasma spp. (13.7%), HPV (12.7%), and Candida spp. (9.4%) were recorded in the MENA region., Conclusions: Most MENA countries lack national STI screening programs, and the reported data are primarily from symptomatic individuals. Establishing robust surveillance systems, addressing stigma and barriers to healthcare access, and expanding STIs screening and vaccination programs are crucial for accurately capturing the true burden of STIs in MENA countries., (© 2024. The Author(s).)

Background: Acinetobacter is a Gram-negative bacterium that causes nosocomial infections, increasing healthcare costs, patient morbidity, and mortality. The rate of carbapenem resistance among Acinetobacter species is rising in several countries, including Saudi Arabia., Objective: To determine the risk factors and compare the predictors of mortality in patients infected with carbapenem-susceptible and carbapenem-resistant Acinetobacter strains., Materials and Methods: This retrospective study included patients with Acinetobacter infection who were admitted to a community hospital in Madinah, Saudi Arabia, between January 2017 and June 2021. A logistic regression analysis was conducted to assess the risks of acquiring carbapenem-resistant Acinetobacter infections and the mortality risk associated with these infections., Results: This study included 138 Acinetobacter -infected cases, of which 114 (82%) were carbapenem-resistant infections. Between 2017 and 2020, resistance rates increased from 75% to 87%. Patients with carbapenem-resistant Acinetobacter infections had higher 90-day mortality than those with carbapenem-susceptible infection (62% vs. 29%, P = 0.006). The risk factors for carbapenem-resistant Acinetobacter infections were prior antimicrobial therapy (aOR: 8.36 [1.69-41.29]; P = 0.009) and mechanical ventilation (aOR: 6.07 [1.82-20.20]; P = 0.003). Among all patients with Acinetobacter infections, significant predictors of 90-day mortality were carbapenem resistance (aOR: 3.26 [1.19-8.90]; P = 0.021) and Charlson comorbidity score (aOR: 1.19 [1.06-1.34]; P = 0.004)., Conclusion: The increase in carbapenem-resistant Acinetobacter cases in this study was consistent with the findings of other studies from Saudi Arabia. This, together with the high associated mortality rates, indicates the urgent need for effective antimicrobials and infection prevention strategies to combat carbapenem-resistant Acinetobacter infections in hospitals., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Saudi Journal of Medicine & Medical Sciences.)

Background: Pediatric patients with sickle cell anemia (SCA) are known to have an increased susceptibility to infections, leading to a higher incidence of fever among this population. However, there is limited literature specifically focusing on the outcomes of pediatric SCA patients presenting to the emergency department (ED) or hospital with a primary diagnosis of fever., Objectives: The objective of this retrospective single-center study was to compare the characteristics of fever and associated symptoms among pediatric patients with SCA, and to investigate the risk factors associated with patients' outcomes and mortality in this specific population., Patients and Methods: The study was conducted at the King Salman Medical City, Maternity and Children's Hospital, Medina, Saudi Arabia, during the period from 2017 to 2022. All pediatric SCA patients under the age of 14, who presented to the ED of the hospital during the study period with a primary diagnosis of fever, were included. The study collected and analyzed clinical, laboratory, treatment, complications, and outcome data of the patients using appropriate statistical methods, including logistic regression., Results: A total of 57 children were included in the analysis. The mean age of the patients was 7.1 ± 4.3 years, with 26 males (45.6%) and 31 females (54.4%). Among the cases, 8 (14%) exhibited fever along with gastrointestinal symptoms, 18 (31.6%) presented with musculoskeletal symptoms, 5 (8.8%) showed neurological symptoms, and approximately half of the cases (45.6%) displayed respiratory symptoms along with fever. Logistic regression analysis identified several significant factors associated with complications in this sample, including a very low level of hemoglobin (Hb) (<7 g/dL) with an odds ratio (OR) of 14.5 (95% CI=1.03-222.3), ICU admission with OR of 14 (95% CI=1.03-186.8), and a hospital stay duration of more than 10 days (OR=11.5; 95% CI=1.10-121.3). Additionally, fever associated with neurological symptoms, neutrophilia, history of splenectomy, and male sex showed positive associations with complications among the studied patients, although not significant., Conclusion: This study provides valuable insights into the characteristics and outcomes of febrile pediatric patients with SCA. The findings highlight the importance of early recognition and management of fever in this vulnerable population, particularly when certain risk factors are present., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. King Salman bin Abdelaziz Medical City Institutional Review Board; Research Ethics Committee of Taibah University issued approval 023-026; IORG0008716-IRB00010413. 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, Zolaly et al.)

Background: The COVID-19 pandemic has introduced major changes in the resuscitation practices of cardiac arrest victims., Aim: We aimed to compare the characteristics and outcomes of patients who sustained in-hospital cardiac arrest (IHCA) during the early COVID-19 pandemic period (2020) with those during the late COVID-19 pandemic period (2021)., Methods: This was a retrospective review of adult patients sustaining IHCA at a single academic centre. We compared characteristics and outcomes of IHCA for 5 months in 2020 with those experiencing IHCA for 5 months in 2021., Results: Patients sustaining IHCA during the early COVID-19 pandemic period had higher rates of delayed epinephrine administration of more than 5 min (13.4% vs. 1.9%; p < 0.01), more frequent delays in the initiation of chest compressions (55.6% vs. 17.9%; p < 0.01), and were intubated less often (23.0% vs. 59.3%; p < 0.01). In terms of outcomes, both return of spontaneous circulation (35.8% vs. 51.2%; p < 0.01) and survival to hospital discharge rates (13.9% vs. 30.2%; p < 0.01) were lower during the early COVID-19 pandemic period., Conclusions: The early COVID-19 pandemic period was associated with delays in epinephrine administration and chest compression initiation for IHCA. Moreover, both return of spontaneous circulation and survival to hospital discharge were lower during the early COVID-19 pandemic period., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

The biological aspect of orthodontic tooth movement is influenced by the magnitude and duration of the applied force. This initiates signaling cascades essential for bone remodeling, which involve activating various cell signaling pathways that enhance the metabolism of the periodontal ligament, leading to localized bone resorption and deposition. This process facilitates tooth movement on the pressure side and promotes healing on the tension side. The remodeling associated with orthodontic tooth movement is an inflammatory reaction involving mediators. Key components in this process include hormones, systemic influences, cyclic adenosine monophosphate, specific cytokines like interleukin 1, colony-stimulating factors, calcium, collagenase, and prostaglandins, all of which are essential for the biological adjustments necessary for tooth movement. Medications that influence molecular pathways critical for the homeostasis of periodontal tissues or that affect changes during orthodontic tooth movement and clastic cell regulation can potentially modulate tooth movement. With the recent increase in prescription medication use, it is essential for clinicians to be aware of medication consumption in prospective patients and understand its potential impact on orthodontic treatment. This review aimed to explore the effects of commonly prescribed medications on the rate of orthodontic tooth movement, thoroughly review the existing evidence on this topic, and identify potential areas for future research., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alrehaili et al.)

Treating plant bacterial diseases is notoriously difficult because of the lack of available antimicrobials. Pseudomonas syringae pathovar syringae (Pss) is a major pathogen of cherry (Prunus avium) causing bacterial canker of the stem, leaf and fruit, impacting productivity and leading to a loss of trees. In an attempt to find a treatment for this disease, naturally occurring bacteriophage (phage) that specifically target Pss is being investigated as a biocontrol strategy. However, before using them as a biocontrol treatment, it is important to both understand their efficacy in reducing the bacterial population and determine if the bacterial pathogens can evolve resistance to evade phage infection. To investigate this, killing curve assays of five MR phages targeting Pss showed that phage resistance rapidly emerges in vitro, even when using a cocktail of the five phages together. To gain insight to the changes occurring, Pss colonies were collected three times during a 66-h killing curve assay and separately, Pss and phage were also coevolved over 10 generations, enabling the measurement of genomic and fitness changes in bacterial populations. Pss evolved resistance to phages through modifications in lipopolysaccharide (LPS) synthesis pathways. Bacterial fitness (growth) and virulence were affected in only a few mutants. Deletion of LPS-associated genes suggested that LPS was the main target receptor for all five MR phages. Later generations of coevolved phages from the coevolution experiment were more potent at reducing the bacterial density and when used with wild-type phages could reduce the emergence of phage-resistant mutants. This study shows that understanding the genetic mechanisms of bacterial pathogen resistance to phages is important for helping to design a more effective approach to kill the bacteria while minimizing the opportunity for phage resistance to manifest., (© 2024 The Author(s). Microbial Biotechnology published by John Wiley & Sons Ltd.)

Background Irritable bowel syndrome (IBS) affects 10-20% of the global population, primarily manifesting as functional issues leading to abdominal discomfort. Key contributors like genetics, psychological factors, weakened immunity, and environmental pollutants play significant roles. Regional variations exist, with prevalence rates ranging from 7-10% in certain areas like South Asia and the Middle East to as high as 20% in many Western countries. Objective The objective of this study is to assess the prevalence of irritable bowel syndrome (IBS) and its related risk factors among the general populace of the Qassim region, Saudi Arabia, aiming to offer valuable insights for healthcare planning and intervention strategies. Methods A cross-sectional descriptive study was conducted, utilizing a validated self-administered questionnaire among residents of the Qassim region aged over 18 years. The questionnaire included demographic information about the participants and the validated Rome IV questionnaire for IBS in adults. Ethical approval for the study was obtained from the Qassim Research Ethics Committee, and data analysis was conducted using R script language version 4.3.3. A significance level of p < 0.05 was employed to interpret the results. Results Overall, significant associations were observed between IBS diagnosis and food allergy (AOR = 2.34, 99% CI: 1.27-4.29), family history of IBS (Adjusted Odd Ratio (AOR) = 7.03, 99% CI: 3.51-15.74), and abdominal pain lasting more than six months (AOR = 2.54, 99% CI: 1.49-4.33). Conclusion This study highlights a high IBS prevalence (21.4%) in Saudi Arabia's Qassim region. While no overall soda-IBS link was found, males showed a protective effect. Significant associations were noted between food allergy, family history, and abdominal pain with IBS diagnosis, especially among females. Further research on gender disparities and familial and abdominal pain roles in IBS management is warranted., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Almuzaini et al.)

Objective:  The study sought to assess the level of awareness regarding osteoarthritis and its management., Methods:  This study was cross-sectional, using data from a sample of 389 individuals from the central region of Saudi Arabia. The participants completed an online questionnaire and ensured anonymity.  Results: A total of 389 participants made up the sample for this study, which had a predominance of females (56.6%, n=220), a majority aged <50 years (66.6%, n=259), and most of them (51.7%, n=201) weighing 60-80 kg, substantial proportion lived in the Riyadh region (27.5%, n=107), with more than half (59.4%, n=231) having a university education and working in offices (28.3%, n=110). The majority (73.3%, n=285) of participants were married, and a vast majority (87.9%, n=342) were not smokers. The findings revealed that only 32.9% (n=128) of the participants had good knowledge about osteoarthritis. The study found that stiffness (80.2%, n=312) and swelling (97.9%, n = 381) are the most common signs and symptoms of osteoarthritis; the risk factors for osteoarthritis were genetic factors (79.7%, n=310) and age (91.3%, n=355). The treatment of osteoarthritis identified in the study included exercises such as swimming (85.1%, n=331), physical therapy (86.6%, n=337), and joint replacement surgery (92.0%, n=358). The study established a statistically significant association between age, education level, previous diagnosis of osteoarthritis, family history of osteoarthritis (p = 0.004, 0.001, 0.002, and 0.001, respectively), and level of knowledge about osteoarthritis. However, there was no statistically significant association between gender, marital status, smoking status, previous knee injuries, physical activity level, and the level of knowledge about osteoarthritis (p > 0.05).  Conclusion: Overall, the study revealed that 32.9% (n=128) of the participants had good knowledge about osteoarthritis. Participants aged 50-60 years, those with a university and post-graduate level of education, as well as those who had a previous diagnosis of osteoarthritis and those with a family history of osteoarthritis, had greater and better knowledge and awareness about osteoarthritis. Joint stiffness and swelling were identified, as the most common signs and symptoms of osteoarthritis. The risk factors identified in the study were genetic factors and age, while the treatment options noted by the study were exercise, such as swimming, physical therapy, and joint replacement surgery. The study notes the need for enhanced public awareness of the problems associated with osteoarthritis among the Saudi Arabian population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Albaker et al.)

Globally, the textile industry contributes to pollution through accidental discharges or discharge of contaminated wastewater into waterways, significantly affecting water quality. These pollutants, including dye molecules, are environmental hazards for aquatic and terrestrial life. The field of visible light-mediated photocatalysis has experienced rapid growth, driven by the utilization of photocatalysts that can absorb low-energy visible light and effectively degrade dyes. In the present study, we report a simple method to controllably synthesize Fe 2 O 3 , ZnO, and ZnFe 2 O 4 using the one-pot synthesis method. In the subsequent step, copper (Cu) was deposited on the surface of ZnFe 2 O 4 (forming ZnFe 2 O 4 -Cu) using a facile, green, and cost-effective method. The synthesized samples were characterized using various techniques, including XRD, UV-Vis DRS, FT-IR, SEM-EDX, HR-TEM, XPS, PL, and BET analysis. These techniques were employed to investigate the composition, morphology, structure, and photophysical properties of as-prepared samples. The ZnFe 2 O 4 -Cu nanocomposite demonstrated efficient photocatalytic activity for degrading RhB dye pollutants under visible light. The photocatalyst was successfully reused for three consecutive cycles without significantly decreasing performance. Furthermore, during the study, the radical scavenging test emphasized the role of different radicals in the degradation of dye pollutants. This research has the potential to enable the efficient production of high-performance photocatalysts that can rapidly eliminate ecologically harmful dyes from aqueous solutions.

Objective Dermatological complaints are one of the most common reasons to see a physician. Identifying the incidence and prevalence of different skin conditions is essential to improve health outcomes. Only a few studies regarding the pattern of skin diseases have been conducted in Saudi Arabia, especially in the Qassim region. This study aims to identify, evaluate, and compare the pattern of skin conditions in the Qassim region regarding age and sex, and to compare the results with previous studies. Methods A retrospective record-based study included all Saudi patients who attended the dermatology clinics at Qassim University Medical City, for 12 months, from 2021/08/26 to 2022/07/1. Data were collected from the electronic medical records. Results The study included 2775 Saudi patients comprising 1654 (59.6%) females and 1121 (40.4%%) males, with a male-to-female ratio of 1: 1.475. Around 75% of patients were between 15 and 34 years of age. The top most common diagnoses were pilosebaceous disorders (49.2%), with acne vulgaris being the predominant condition, followed by hair disorders (15.6%), dermatitis (9.2%), pigmentary disorders (7.2%), infections (3.9%), and papulosquamous disorders (3%). The prevalence of dermatological conditions was significantly higher in females than males for pilosebaceous disorders (P=.01) and hair disorders (P=.02). Conclusion There is a changing trend in the prevalence of skin disorders in the Qassim province of Saudi Arabia. Pilosebaceous disorders are being diagnosed more frequently compared to previous years and females visit dermatology clinics more than males. Due to its hospital-based setting, this study only gives a rough estimate of the pattern of skin diseases, and extensive epidemiological studies are needed to estimate the prevalence accurately., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alfouzan et al.)

Background Thyroid cancer incidence has been increasing worldwide over the last few decades. It is the most common endocrine cancer and is most common among females. The study contributes to filling the knowledge gap among Saudi people regarding thyroid cancer. Objectives This research aims to investigate the level of thyroid cancer knowledge and awareness in Saudi Arabia, identify potential knowledge gaps, and develop targeted strategies for enhancing public awareness and education. Methods A cross-sectional, voluntary online survey was conducted from 1st August 2023 to 1st October 2023 among residents living in Saudi Arabia over 18 years of age. The participants included were 2030 respondents. Data analysis was performed using RStudio (R version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria). Results Among the participants, the majority were female (60.4%). A total of 49.7% of the individuals reported having a moderate to high level of knowledge about thyroid cancer. While 63.9% knew the association of a lump in the neck to thyroid cancer, 82.6% affirmed to consult a doctor upon discovering a lump, 72.1% knew that regular monitoring of neck lumps is crucial for early diagnosis and treatment of precancerous conditions, 38.7% were aware of females being prone to thyroid cancer, and 59.2% were aware of the link between lifestyle and increased risk. Higher awareness scores were positively associated with female gender, previously having thyroid function tests done, and previously undergoing a US scan of the thyroid. Conclusion In this study, Saudi individuals are reported to lack some aspects of knowledge and perception of thyroid cancer. This study emphasizes filling the existing knowledge gap in thyroid cancer awareness in the Saudi population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Qusty et al.)

Introduction: Human Immunodeficiency Virus infection continue to represent a global health concern influenced by various social, economic, and cultural factors. The MENA are among the top regions in the world with the fastest-growing HIV epidemic. Thus, adequate knowledge and a positive attitude of people toward HIV/AIDS are of utmost importance to prevent the spreading of the disease. Accordingly, this study aims to evaluate the knowledge and attitude of the public and healthcare population toward HIV/AIDs., Methods: A cross-sectional analysis was conducted among residents within our population from October 2018 until August 2019. An anonymous online questionnaire was used to investigate the population's demographic characteristics, HIV/AIDS-related knowledge, and attitudes toward HIV-infected patients. Participants completed a 40-item questionnaire designed to measure their knowledge and attitude toward HIV/AIDS. The data was collected via surveys, administered through electronic tablets to the participants at public places (n = 5,757) and through an online version of the questionnaire on Google Forms (n = 2500), which was sent through social media platforms. Descriptive statistics were used to analyse the data using the R-statistical software program., Results: A total of 8,257 participants were included in our analysis. Saudi Arabian citizens represented 79% of the participants, while participants from the MENA countries represented 11.7% and 3% from the other Gulf Cooperation Council countries. Fifty-nine (59%) knew that HIV is a contagious infection, and 13.8% were unaware that HIV could be transmitted sexually. A few healthcare professionals reported negative attitudes toward HIV infected patients. Many risk factors, including age, gender, nationality, and education, significantly affected the knowledge and attitude scores. In this survey, we found that social media is the primary source of participants' information., Conclusions: Overall correct knowledge score of individuals about HIV/AIDS was relatively low. This study showed that the general population was knowledgeable to a certain degree about HIV/AIDS and its modes of transmission. Nevertheless, they lack a detailed understanding of the disease's nature, modes of transmission, and existing treatment. Policymakers in the region should further eliminate social discrimination and stigma in HIV-infected patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Elghazaly et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This article reports on incorporating magnetic nanoparticles into natural carbon frameworks derived from Nigella Sativa seeds and their synthesis via co-precipitation reactions for application in biomedicine. The magnetic Nigella Sativa Seeds (Magnetic NSS), a metal oxide-based bio-nanomaterial, has shown excellent water diaper presence due to the presence of a wide range of oxygenous hydroxyl and carboxyl groups. The physicochemical properties of the composites were characterized extensively using Fourier transform infrared spectroscopy (FTIR), powder-X-ray diffraction (XRD), scanning electron microscopy (SEM), elemental analysis, transmission electron microscopy (TEM), and vibrating-sample magnetometer. Furthermore, synthesized magnetic NSS showed antioxidant and antifungal activity. The antifungal susceptibility was further tested against Candida albicans with a MIC value of 3.125 µg/mL. Analysis of antioxidant defense enzymes was determined quantitatively; the results suggested that antioxidant enzyme activity increase with increased magnetic NSS concentration. Furthermore, biofilm inhibition assay from scanning electron microscopy results revealed that magnetic NSS at the concentration of 3.5 μg/mL has anti-biofilm properties and can disrupt membrane integrity.

Currently, researchers are working to contribute to the emerging fields of cloud computing, edge computing, and distributed systems. The major area of interest is to examine and understand their performance. The major globally leading companies, such as Google, Amazon, ONLIVE, Giaki, and eBay, are truly concerned about the impact of energy consumption. These cloud computing companies use huge data centers, consisting of virtual computers that are positioned worldwide and necessitate exceptionally high-power costs to preserve. The increased requirement for energy consumption in IT firms has posed many challenges for cloud computing companies pertinent to power expenses. Energy utilization is reliant upon numerous aspects, for example, the service level agreement, techniques for choosing the virtual machine, the applied optimization strategies and policies, and kinds of workload. The present paper tries to provide an answer to challenges related to energy-saving through the assistance of both dynamic voltage and frequency scaling techniques for gaming data centers. Also, to evaluate both the dynamic voltage and frequency scaling techniques compared to non-power-aware and static threshold detection techniques. The findings will facilitate service suppliers in how to encounter the quality of service and experience limitations by fulfilling the service level agreements. For this purpose, the CloudSim platform is applied for the application of a situation in which game traces are employed as a workload for analyzing the procedure. The findings evidenced that an assortment of good quality techniques can benefit gaming servers to conserve energy expenditures and sustain the best quality of service for consumers located universally. The originality of this research presents a prospect to examine which procedure performs good (for example, dynamic, static, or non-power aware). The findings validate that less energy is utilized by applying a dynamic voltage and frequency method along with fewer service level agreement violations, and better quality of service and experience, in contrast with static threshold consolidation or non-power aware technique.

Background: It is debatable whether erythromycin has similar efficacy to other macrolides in treating community-acquired pneumonia (CAP). The aim of this meta-analysis is to compare the efficacy of erythromycin with clarithromycin and azithromycin., Methods: We performed this meta-analysis of randomized controlled trials (RCTs) of adults or adolescents with CAP which compared the efficacy of erythromycin monotherapy to either azithromycin or clarithromycin. We searched PubMed and EMBASE and Cochrane Library databases and three clinical trial registries up to November 02, 2021. We evaluated heterogeneity and used random-effects models to perform risk ratios with 95% confidence intervals., Results: We included four RCTs (total of 472 patients), which compared the clinical efficacy of erythromycin versus clarithromycin. No studies comparing monotherapy of erythromycin versus azithromycin were found. Erythromycin use was associated with significantly lower rates of clinical success (RR, 0.79; 95% CI, 0.64 to 0.98; P-value = 0.033; I 2  = 20.27%), clinical cure (RR,0.67; 95% CI, 0.48 to 0.92; P-value = 0.014; I 2  = 8.75%), and radiological success (RR, 0.84; 95% CI, 0.71 to 0.996; P-value = 0.045; I 2  = 20.12%) than clarithromycin., Conclusion: Erythromycin is less effective than clarithromycin as empiric treatment of CAP in adults and adolescents. Because of this and the higher rate of adverse reactions, erythromycin should not be used in the majority of CAP patients when azithromycin and clarithromycin are available., (Copyright © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Background: Tumor protein 53 ( TP53 ) is a tumor-suppressor gene and plays an essential role in apoptosis, cell cycle arrest, genomic stability, and DNA repair. Although it is the most often mutated gene in human cancer, it has respectively low frequency in hematological malignancy but is significantly linked with complex karyotype, poor prognosis, and chemotherapeutic response. Nevertheless, the prevalence and prognostic role of TP53 mutations in hematological malignancy in Saudi patients are not well reported. We, therefore, aim to assess the frequency of TP53 mutations in hematological malignancies in Saudi Arabia., Method: 20 different hematological malignancy samples were tested using fluorescence in situ hybridization (FISH) technique for TP53 deletion detection and next-generation sequencing (NGS) targeted panel was applied on 10 samples for mutations identification specifically TP53 mutation., Results: TP53 deletion was detected in 6 of 20 samples by FISH. Most of the 6 patients with TP53 deletion had acute lymphoblastic leukemia (ALL), and majority of them were child. NGS result revealed one heterozygous missense mutation in exon 5 of the TP53 gene (c. G9963A, p.H175R)., Conclusion: To the best of our knowledge, the TP53 mutation is novel variant, and the first time we are reporting their association with myelodysplastic syndromic individual with complex karyotype. This study recommends further analysis of genomic mutations on bigger cohorts, utilizing high throughput technologies.

Background: Psychological impacts among healthcare professionals have increased significantly due to the increasing number of COVID-19 cases. This study aimed to identify stress and coping strategies among healthcare professionals in Saudi Arabia during the COVID-19 outbreak., Subjects and Methods: A cross-sectional study online survey was conducted for health care professionals during a peak of COVID-19 from March to June 2020 at different healthcare institutions at KSA (n=342)., Results: Sixty-five percent of responders often and always feel fears about infection and subsequent effects on themselves, the patient, and the family. 57% of them stated that they felt sometimes depressed mode and 47% anxiety during the outbreak. Eighty-four percent of the respondent always focusing on prevention as the first biosecurity measures such as hand-washing habits and using hand sanitizer, and 38.3% of them make sometimes relax and rest. While half of the responses (50%) sometimes had physical exercise. Also, thirty-eight percent joined sometimes community and/or group online chat groups, and 56.1% always keep contact with family and friends through social messaging or phone calls., Conclusion: Understanding this topic is important for healthcare organizations, effective strategies, and programs is needed to provide holistic staff care and wellbeing during outbreaks that focus on the value of mental and emotional support.

Background: Lymphedema is a condition in which excessive fluid accumulates in soft tissues. It is a common complication of breast cancer treatments. It can lead to serious consequences and interfere with the activity of daily living. This study aimed to determine the level of awareness of breast-cancer-related lymphedema (BCRL) among women with breast cancer in the Kingdom of Saudi Arabia. This was a descriptive quantitative cross-sectional design that included a convenience sample of women diagnosed with breast cancer in the Kingdom of Saudi Arabia. Data were collected by distributing a self-administrated online questionnaire consisting of four parts, including demographic data (five items), the status of education about BCRL (three items), basic medical history of breast cancer (six items), and BCRL level of awareness of risk factors and management (nine items)., Results: In total, 95 out of 135 of participants did not know about lymphedema, 119 of the participants (88.1%) did not receive any explanation about the possibility of lymphedema from their medical team before surgery, and 121 of them (89.6%) did not receive it after surgery. The most significant factor affecting participants' level of awareness regarding BCRL was the lack of information about the possibility of BCRL occurrence, which was not provided to them by the medical team., Recommendation: Early and continuous education for future management is essential to prevent problems related to BCRL and improve quality of life.

Background: Most paediatric orthopaedic problems referred to paediatric orthopaedists are usually self-limited, requiring observation and reassurance. Higher parental expectations may have resulted in higher referral rates. This study was conducted to assess awareness and knowledge about the diagnosis and management of some common normal variants of musculoskeletal paediatric development among paediatricians and primary health care physicians., Method: A self-administered questionnaire (tested for validity and reliability) was distributed between November 2016 and June 2017. Of 300 questionnaires, 189 (63% response rate) were obtained from 106 paediatricians, 57 family physicians, and 26 general practitioners (GPs)., Results: Paediatricians accounted for 56% of participants, 30.2% were family physicians, and 13.8% were GPs. Correct answer rates ranged between 9% and 66.1%. Inadequate knowledge of common paediatric orthopaedic problems was found in 87.3% of participants. With parental insistence, 75.7% of physicians referred a case, regardless of necessity, whereas inappropriate referral for medicolegal issues was reported by 62.4%. The study showed that paediatricians were less likely than family physicians and GPs to refer inappropriately (67% versus 87.7% and 84.6%, respectively; p = 0.007). Physicians who reported that more than 10% of their training was in orthopaedics were more likely to inappropriately refer orthopaedic cases compared to those who reported a higher percentage of orthopaedic training (82.1% versus 66.7%)., Conclusion: Inappropriate paediatric orthopaedic referrals are increasing. The results clearly point to the need for increased musculoskeletal education during undergraduate medical and residency training in paediatrics and family medicine. New guidelines should be implemented and updated regularly. Educational material for parents (posters, videos, etc.) should be considered.

In this report, we introduce a case of erosive polyarthritis in a 55-year-old female diagnosed with Mycobacterium abscessus pulmonary infection. Her arthritis has been worsened after use of DMARDs. The patient demonstrated a significant response to the antimicrobial regimen that was administered. We call special attention to the possibility of Mycobacterium abscessus being a cause of reactive polyarthritis, particularly if symptoms worsened after use of disease-modifying antirheumatic drugs (DMARDs), but further studies are necessary for clarification.