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Background: In Saudi Arabia, herbal medicine is an essential component of traditional health practices, reflecting a deep cultural appreciation for natural remedies. Despite widespread use, comprehensive data on perceptions and utilization among general practice patients are scarce. This study aims to elucidate the patterns of herbal medicine use, associated beliefs, and communication with healthcare professionals in this context., Methods: A cross-sectional survey was conducted using an online questionnaire distributed through social media and professional networks, targeting adult residents of Saudi Arabia. The survey encompassed questions on demographic characteristics, use of herbal medicine, reasons for use, sources of herbal products, perceptions of efficacy and safety, and discussions with healthcare professionals about herbal medicine usage., Results: The survey was completed by 1,184 participants, with 736 (62%) reporting the use of herbal medicines in the past 12 months. Among these users, the age group 30-39 was most represented (328/1,184, 27.8%), while participants over 60 were the least (66/1,184, 5.6%). Herbal medicines were primarily used for general wellness (332/736, 45%) and treatment of specific ailments (221/736, 30%). The majority obtained their herbal medicines from pharmacies (427/736, 58%), and 294 (40% of users) used them as alternatives to prescribed medications. Only 259 (35% of herbal medicine users) had discussed their usage with healthcare professionals. Most users believed in the safety (515/736, 70%) and effectiveness (478/736, 65%) of herbal remedies, with a significant portion (626/736, 85%) advocating for more scientific research., Conclusion: This study reveals a significant engagement with and positive perception of herbal medicine among general practice patients in Saudi Arabia, alongside a notable gap in communication between patients and healthcare providers. The findings highlight the need for integrating discussions on herbal medicine into patient care, encouraging evidence-based, safe use through better-informed healthcare practices., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ali et al.)

Consanguineous marriages, where spouses are related by blood, have been a longstanding practice in human history. The primary medical concern with consanguineous marriages is the increased risk of genetic disorders. When closely related individuals reproduce, there is a higher probability that both parents carry the same genetic mutation. In Arab countries, especially Saudi Arabia, the rate of consanguineous marriage is high compared with Western European and Asian countries. This high rate is directly proportionate with elevated risk of genetic disorders, including congenital heart diseases, renal diseases, and rare blood disorders. Additionally, it was noted that the rate of negative postnatal outcomes is higher in consanguineous marriages compared with the general population. These observations indicate the necessity of tackling this area and highlighting the consequences of this practice. In this review, we aim to discuss the current evidence regarding the association between consanguineous marriages and genetic disorders in Saudi Arabia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Khayat et al.)

Objectives This study aimed to assess the prevalence and distribution of dental pulp stones and evaluated their possible associations with local and systemic factors in the Makkah population in Saudi Arabia. Materials and methods Archived cone-beam computed tomography (CBCT) images for 390 patients, from the electronic health records (EHR) in the Dental Teaching Hospital, Umm Al-Qura University, were used. Images were examined in all planes (coronal, sagittal, and axial) for a discrete radiopaque mass in the pulp of all teeth, in both arches. The teeth conditions (the presence of caries, restoration, the periodontal condition, and the presence of pulp stones) were recorded. Additional patient information, including age, gender, and medical condition, was obtained from the patients' archived files. The collected data were statistically analyzed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) software; a p-value of ≤ 0.05 is considered statistically significant. Results Pulp stone prevalence was 78.97% of the subjects (308 out of 390) and 15.92% of the examined teeth (1644 out of 10326). There were statistically significant differences regarding nationality (p=0.043) and age (p=0.023) but no significant difference between males and females (p=0.876), maxillary and mandibular teeth (p=0.392), and right and left sides (p=0.222) in pulp stone prevalence. Significant differences were found between pulp stone prevalence of sound versus and carious and restored teeth and between periodontally affected teeth and periodontally healthy teeth (p=0.031). Conclusion The prevalence of pulp stones in the Makkah population is high. A positive association was found between nationality, age, tooth restorations, caries, periodontal diseases, and pulp stone prevalence, but no correlation was found with patients' health or gender. The molars were the most affected teeth, while the incisors were the least., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Kenawi et al.)

Introduction: Herbal medicine is a medical system based on the utilization of plants or plant extracts for therapy. The continual increase in global consumption and the trade of herbal medicine has raised safety concerns in many regions. These concerns are mainly linked to microbial contamination, which could spread infections with multi-resistant bacteria in the community, and heavy metal contamination that may lead to cancers or internal organs' toxicity., Methods: This study was performed using an experimental design. A total of 47 samples, herbal medicine products sold in local stores in Qassim region, were used in the experiments. They were tested for bacterial contamination, alongside 32 samples for heavy metal analysis. Bacterial contamination was determined by the streak plate method and further processed to determine their antimicrobial susceptibility patterns using MicroScan WalkAway96 pulse; heavy metals were determined using a spectrometer instrument., Results: A total of 58 microorganisms were isolated. All samples were found to be contaminated with at least one organism except three samples. The majority of the isolated bacterial species were gram negative bacteria, such as Klebsiella spp., Pseudomonas spp. and E. coli., which could be of fecal origin and may lead to pneumonia, skin, or internal infections. Furthermore, most of the gram-positive bacteria were found to be multi-drug resistant. Moreover, for heavy metals, all samples had levels exceeding the regulatory limits., Conclusion: This study demonstrated the presence of bacteria and heavy metals in samples of herbal medicines. Using these contaminated products may spread resistant infections, metal toxicities, or even cancers in the community., (© 2023. The Author(s).)

The incidence of extrapulmonary tuberculosis (EPTB) in low- and middle-income countries, as well as, high-income countries has increased over the last two decades. The acid-fast bacillus (AFB) smear test is easy to perform and cost-effective with a quick turnaround time but the test has low sensitivity. Culture remains the gold standard for detecting TB; however, it has low sensitivity and slow bacterial growth patterns, as it may take up to 6 to 8 weeks to grow. Therefore, a rapid detection tool is crucial for the early initiation of treatment and ensuring an improved therapeutic outcome. Here, the Xpert Ultra system was developed as a nucleic acid amplification technique to accelerate the detection of MTB in paucibacillary clinical samples and endorsed by the World Health Organization. From March 2020 to August 2021, Xpert Ultra was evaluated for its sensitivity and specificity against EPTB and compared with those of the routinely used Xpert, culture, and AFB tests in 845 clinical samples in Saudi Arabia. The results indicate the overall sensitivity and specificity of Xpert Ultra to be 91% and 95%, respectively, compared with the Xpert (82% and 99%, respectively) and AFB smear (18% and 100%, respectively) tests. The results also indicated that despite the low microbial loads that were categorized as trace, very low, or low on Xpert Ultra, yet, complete detection was achieved with some sample types (i.e., 100% detection). Consequently, Xpert Ultra has great potential to replace conventional diagnostic approaches as a standard detection method for EPTB., (© 2023. The Author(s).)

Background The choice of anesthesia for an elective cesarean section should be based on an individual benefit-risk assessment, considering the pregnant woman's preferences, concerns, and the available medical expertise. This study aimed to determine the preferences for general and spinal anesthesia among women undergoing elective cesarean sections and the factors affecting their choice. Methods The study design is a cross-sectional study, and it was conducted on pregnant women to measure the acceptance of general anesthesia and spinal anesthesia in patients with elective cesarean sections in Saudi Arabia. Random pregnant women were invited to participate in this study across Saudi Arabia after fulfilling the inclusion criteria. A digital questionnaire was distributed across Saudi Arabia to be filled out by female residents. A Microsoft Excel (Microsoft Corporation, Redmond, Washington, USA ) sheet was used for data entry, while IBM SPSS software version 27.0.1 (IBM Corp., Armonk, New York, USA) was used for statistical analysis. Results The study included 813 participants; most (28%) of them were 25-30 years old. Of the study participants, 54% had chosen spinal anesthesia before, 22% had chosen general anesthesia, and 24% had chosen neither. Reasons to choose general anesthesia were reported as follows: 21.6% feared pain during surgery, 24.2% feared watching the surgical procedures on their bodies, 16.6% feared back pain, 12.8% feared being paralyzed, and 15.1% feared needles used to administer anesthesia in the lower back. Reasons for choosing spinal anesthesia were reported as follows: 26.3% had back pain concerns; 13% feared prolonged unconsciousness; 9.6% feared having a headache after surgery; 17% had post-surgery pain concerns; 30.1% wanted to be alert at the time of the birth of the baby; 10.6% feared the chances of experiencing nausea and vomiting; and 7.4% feared not being able to breastfeed. Conclusion Spinal anesthesia was chosen by more participants than general anesthesia. There was a statistically significant association between choosing spinal anesthesia and the number of previous pregnancies, parity, history of preterm labor, and recommendation to undergo general or spinal anesthesia by non-medical staff. It was also significant with the older age and higher educational level of participants. This decision may be influenced by a number of variables, the most significant of which are prior experience with general anesthesia or spinal anesthesia, educational attainment, and non-medical advice., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Tawfeeq et al.)

Background and Objectives : Patients undergoing liver transplantation (LT) often require increased blood product transfusion due to pre-existing coagulopathy and intraoperative fibrinolysis. Strategies to minimise intraoperative bleeding and subsequent blood product requirements include platelet transfusion and tranexamic acid (TXA). Prophylactic TXA administration has been shown to reduce bleeding and blood product requirements intraoperatively. However, its clinical use is still debated. The aim of this study was to report on a single-centre practice and analyse clinical characteristics and outcomes of LT recipients according to intraoperative treatment of TXA or platelet transfusion. Materials and Methods : This was a retrospective observational cohort study in which we reviewed 162 patients' records. Characteristics, intraoperative requirement of blood products, postoperative development of thrombosis and outcomes were compared between patients without or with intraoperative TXA treatment and without or with platelet transfusion. Results : Intraoperative treatment of TXA and platelets was 53% and 57.40%, respectively. Patients who required intraoperative administration of TXA or platelet transfusion also required more transfusion of blood products. Neither TXA nor platelet transfusion were associated with increased postoperative development of hepatic artery and portal vein thrombosis, 90-day mortality or graft loss. There was a significant increase in the median length of intensive care unit (ICU) stay in those who received platelet transfusion only (2.00 vs. 3.00 days; p = 0.021). Time to extubate was significantly different in both those who required TXA and platelet transfusion intraoperatively. Conclusions : Our analysis indicates that LT recipients still required copious intraoperative transfusion of blood products, despite the use of intraoperative TXA and platelets. Our findings have important implications for current transfusion practice in LT recipients and may guide clinicians to act upon these findings, which will support global efforts to encourage a wider use of TXA to reduce transfusion requirements, including platelets.

Background: Drug adherence has been extensively evaluated in many developed countries in the West using different methods of medication adherence measurement; however, there are relatively few reports studying the adherence levels among Saudi patients. Thus, this study will evaluate the adherence to cardiovascular medicines in Saudi patients visiting (PSCC) in Al-Qassim, Saudi Arabia., Methods: This cross-sectional observational study relied on self-administered questionnaires. This study used the Morisky, Green, and Levine (MGL) Adherence Scale, also known as the MAQ (Medication Adherence Questionnaire), in PSCC's pharmacy waiting room in Qassim, Saudi Arabia., Results: This study included 993 PSCC pharmacy waiting room patients. The patients were between 11 and 50 years old, and 52.7 percent were male. Most participants (71.2%) were above 50, while 16.3% were 41-50. Non-adherent patients cited traveling or being busy (28.6%), forgetting (18.7%), daily multi-medications (7.1%), being sleepy or sleeping (6.6%), and not repeating the prescription (6.6%). The Medicine Adherence Questionnaire indicated that 62.6 percent of patients fully adhered to their medications, and 21.6 percent usually adhered. Only drug adverse effects affected adherence (p =0.0001)., Conclusion: The current study showed that there is a good level of adherence among patients with cardiovascular diseases toward their diseases. The most common reasons for neglecting medications include traveling or being busy, forgetting multiple medications, and being tired or sleeping. Having experience with side effects was the only significant factor affecting adherence to medications., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Short tandem repeats (STRs) have been used for various identity typing methods worldwide. They have high discrimination power in human identification in forensics, paternity testing, missed personal identification, genetic diseases, and gene regulatory functions. They have also been used to detect and monitor the stability of diseases, including various types of cancer. This study aimed to investigate the impact of leukemia on the detection and stability of STR markers., Methods: DNA was isolated from 30 participants (15 with chronic myeloid leukemia( CML) and 15 healthy controls) and used to amplify STR markers using specific primers., Results: We found that the blood of those with leukemia had more 9.3 and 9 alleles at the tyrosine hydroxylase 1 (TH01) marker than the blood of the healthy control samples. The results of this study will help researchers understand leukemia's effect on the detection and stability of STR markers in leukemic patients compared to healthy individuals., Conclusion: Our results demonstrate that STR markers could become useful in genetic studies of leukemia cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alharbi et al.)

Coinfections and comorbidities add additional layers of difficulties into the challenges of COVID-19 patient management strategies. However, studies examining these clinical conditions are limited. We have independently investigated the significance of associations of specific bacterial species and different comorbidities in the outcome and case fatality rates among 129 hospitalized comorbid COVID-19 patients. For the first time, to best of our knowledge, we report on the predominance of Klebsiella pneumoniae and Acinetobacter baumannii in COVID-19 non-survival diabetic patients The two species were significantly associated to COVID-19 case fatality rates ( p -value = 0.02186). Coinfection rates of Klebsiella pneumoniae and Acinetobacter baumannii in non-survivors were 93% and 73%, respectively. Based on standard definitions for antimicrobial resistance, Klebsiella pneumoniae and Acinetobacter baumannii were classified as multidrug resistant and extremely drug resistant, respectively. All patients died at ICU with similar clinical characterisitics. Of the 28 major coinfections, 24 (85.7%) were in non-survivor diabetic patients, implying aggravating and worsening the course of COVID-19. The rates of other comorbidities varied: asthma (47%), hypertension (79.4%), ischemic heart disease (71%), chronic kidney disease (35%), and chronic liver disease (32%); however, the rates were higher in K. pneumoniae and were all concomitantly associated to diabetes. Other bacterial species and comorbidities did not have significant correlation to the outcomes. These findings have highly significant clinical implications in the treatment strategies of COVID-19 patients. Future vertical genomic studies would reveal more insights into the molecular and immunological mechanisms of these frequent bacterial species. Future large cohort multicenter studies would reveal more insights into the mechanisms of infection in COVID-19.

Rapid, reliable results can be given by molecular, direct detection and identification of the Mycobacterium tuberculosis (MTB/Mtb) complex from clinical samples. The Xpert MTB/RIF assay is an assay that has been availablefor more than a decade for identification of Mycobacterium tuberculosis and resistance to rifampicin. However, there is minimal evidence on its clinical usefulness in paucibacillary, non-respiratory samples. The Xpert MTB/RIF assay clinical utility index, its diagnostic characteristics and the number required to diagnose 2935 non-respiratory specimens submitted for routine mycobacterial work-up in a reference laboratory in an intermediate prevalence setting per specimen form were evaluated. The Xpert MTB/RIF assay showed a variable clinical utility index and number required to diagnose (NND) depending on the type of specimen, which was moderate in tissue biopsies (NND = 1.8) and excellent in pus and urine samples, compared to acid-fast microscopy and culture as a gold standard technique (NND = 1.1 and 1.2). Microscopy, on the other hand, consistently showed a weak to fair index of clinical usefulness in all specimen forms, with in NND of 2.3-12.5. The NND for detecting tuberculous infection in the cerebrospinal fluid by the Xpert MTB/RIF assay was noted to be 1.2, with a moderate clinical utility index of 0.8. The evidence presented indicates that the overall appropriate diagnostic utility of the Xpert MTB/RIF assay is clinically successful in most non-respiratory samples. To check the cost-effectiveness and prognostic effect of integrating this completely automated molecular-based assay into the routine testing algorithm for non-respiratory mycobacterial specimens, further data must be collected., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier B.V. on behalf of King Saud University.)

Tree species (including Eucalyptus camaldulensis, Ziziphus spina-christi, Albizia lebbeck, Prosopis juliflora, Pithecellobium dulce, and Ficus altissima) were investigated to elucidate their appropriates for green belt application. Leaf samples were collected from four different locations in Riyadh: (1) residential; (2) dense traffic; (3) industrial; and (4) reference sites located approximately 20 km away from the city of Riyadh. Leaves collected from the industrial site showed the highest leaf area reduction. The smallest reduction of leaf areas was observed for F. altissima (11.6%), while the highest reduction was observed for P. juliflora (34.8%). Variations in the air pollution tolerance index (APTI) coupled with the anticipated performance index (API) for each species were examined. The APTI value of Z. spina-christi was highest (58.5) at the industrial site while the lowest APTI value was for P. juliflora (14) at the reference site. Correlation coefficient and linear regression analyses determined that the correlation between the ascorbic acid content and APTI is positive and significantly strong. Our findings indicate that urban green planning in Riyadh should include growing F. altissima on roadsides as well as in heavy industrial locations followed by Z. spina-christi and A. lebbeck according to their API and APTI performances.

Background: Polypharmacy is meaningful and clinically justified under certain circumstances. However, the prescription of multiple psychiatric medicines is mostly based on practical experience rather than evidence. The aim of this study was to assess the current practice of and factors associated with the use of polypharmacy among patients attending outpatient psychiatric clinics., Materials and Methods: A cross-sectional study was conducted among patients attending outpatient psychiatric clinics in two tertiary care hospitals in the kingdom of Saudi Arabia (KSA). Patients aged 18 years and above and who were taking any prescription or nonprescription medications were included. Data were collected by face-to-face interviews, followed by a review of electronic medical charts to determine the drugs being taken by patients, and track their current computerized drug prescriptions. Data were analyzed using SPSS statistical software version 21 (Chicago, IL, USA), applying both descriptive and inferential statistical analysis as appropriate., Results: Of the 401 study participants, 53.6% were aged 25 years or older, and 63.6% were married and > 50% were unemployed. The overall prevalence of polypharmacy was 46.9%. The prevalence of polypharmacy was 67.3% in psychosis, 37.7% in depression, 27.1% in anxiety, 74.1% in bipolar disorders, and 53.6% for patients with two or more disorders, and 42.1% for patients diagnosed with "other" disorders. Overall, there was a significant association between polypharmacy and gender, marital status, and diagnosis of disorder., Conclusions: Psychotropic polypharmacy is common in outpatient practice. Patients with psychosis and bipolar disorders, especially those aged 25-45 years are exposed to high psychotropic polypharmacy. The concomitant use of large numbers of drugs should be periodically reviewed to improve the quality and safety of psychiatric care., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Family and Community Medicine.)

Recreational use of anabolic-androgenic steroids (AAS) is a growing worldwide public health concern. However, studies assessing the level of awareness and knowledge of its effects on health are fairly limited, especially in developing countries, including Saudi Arabia. This community-based cross-sectional study was conducted to assess knowledge, attitudes and practices among male gym members toward AAS in Riyadh (Saudi Arabia) from March to October 2016. Twenty gyms were randomly selected from four different geographical regions (clusters) within Riyadh. In total, 482 participants responded to the self-administered anonymous questionnaire, which covered socio-demographic data, data assessing knowledge, attitude and behavior related to AAS use. The mean (±standard deviation) age of study participants was 27.2 (±6.9) years. Among these, 29.3% of participants reported having used AAS, while the majority (53.5%) reported hearing of AAS use, mostly through friends. Most study participants reported awareness of the effects of AAS on muscle mass, body weight and muscles strength (53.2%, 51.1% and 45.5%, respectively). In contrast, a higher proportion of study participants were unaware of the side-effects of AAS use. A high proportion of study participants (43.2%) reported that they had been offered AAS and 68.7% believed that AAS are easily accessible. Most of the gym users (90.1%) reported never having used any narcotics or psychoactive drugs. Regression analysis revealed that use of anabolic-androgenic steroids is significantly associated with "weight lifting practice" OR [95%CI] = 1.9[1.02 - 3.61], P = 0.044; "using supplementary vitamins, OR [95%CI] = 7.8[4.05 - 15.03], P < 0.0001, knowing anyone using anabolic-androgenic steroids' OR [95%CI] = 7.5[3.78 - 14.10], P < 0.0001, and someone advised Gym users to take anabolic-androgenic steroids" OR [95%CI] = 2.26[1.23 - 4.14], P < 0.008. Our findings suggest that the level of awareness regarding the possible side-effects of AAS is fairly limited. Thus, efforts directed toward educating the public and limiting access to AAS as well as health policy reforms are crucial to reduce future negative implications of AAS use.