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Background: Inpatient case-based teaching is used in morning report (MR). In light of the quick changes in medical practice, it's critical to gauge the residents' opinions of this teaching approach. In order to determine the viewpoint of emergency medicine residents on different parts of morning reports and to suggest a format based on our observations, our study used an observational cross-sectional methodology. Methods: Residents of King Saud Medical City (KSMC), King Salman Hospital, Aliman General Hospital, and Imam Abdulrahman Alfaisal Hospital participated in an observational cross-sectional survey on morning reports. The residents were given a 22-item questionnaire that asked them about the objective, structure, and substance of the morning report as well as who would be the best choice to present and conduct it and how frequently it should be done. The statistical program "Statistical Package for Social Sciences" was used for the analyses (SPSS). Results: 88.6% of residents agreed that the morning report should be presented by the post-call faculty. 53.3% of respondents said they preferred a general internist, while the chief resident who was conducting the report received a nearly identical response rate (54.6%). Discussion of particular intriguing instances was preferred by 34.6% of the residents since it would aid those 70% more in their post-graduate exams. The residents strongly agreed that management difficulties (86.6%) and diagnostic workup (90%) should be discussed in the morning report. Evidence-based medicine (66.6%) and disease processes (67.3% each) received equal ratings. Conclusion: Morning reports are a valuable instructional tool and ought to be a requirement of all postgraduate residency programs, both domestically and abroad.

Clinical, laboratory and outcome data were reviewed for pediatric patients who were diagnosed with chronic myeloid leukemia (CML) and managed at two tertiary care hospitals in Saudi Arabia, between January 2011 and December 2017 to assess the response to tyrosine kinase inhibitors (TKI) focusing on the monitoring of BCR-ABL fusion gene transcript levels and to look at the overall outcome.CML patients were identified based on the cytogenetic and molecular results.Twelve pediatric patients diagnosed with CML at a median age of 8.4 year; treated with TKI as first-line therapy, 11 (91.7%) patients were started with imatinib (first-generation TKI), while one received dasatinib (second-generation TKI) due to his three-way Philadelphia chromosome sensitivity. Eight patients (72.7%) starting on imatinib were switched to dasatinib (six patients due to drug resistance, and two patients due to intolerance of Imatinib) and two patients (25%) of whom had already achieved major molecular response (MMR) on Imatinib. Response rate to imatinib in terms of achieving MMR as first-line therapy was achieved in five out of 11 patients (45.5%) and only three of them continued to maintain their MMR. Six out of eight patients who were switched to dasatinib achieved MMR. Two patients underwent hematopoietic stem cell transplant (SCT): one due to blast crisis and one due to the side effects of TKI. With a median follow-up time of 78 months (range, 40.5-108), all of our patients were alive at last update.We report an excellent outcome with an overall survival (OS) of 100% at 5-year and disease-free survival (DFS) of 91.7% (8.0%). All our patients achieved MMR and only one patient had loss of MMR on follow-up. Eight patients (66.7%) achieved complete molecular response (CMR).

Aim: The outcome of T-cell acute lymphoblastic leukemia (T-ALL) has improved with the use of pediatric-inspired protocols in the adolescents and young adults (AYA) population. There is limited literature regarding the outcome of T-ALL/lymphoblastic lymphoma (LBL) AYA patients treated with pediatric protocols. Methods: A total of 35 T-ALL/LBL-AYA patients ages between 14 and 55 years were treated with AYA-15 protocol. Results: At a median follow-up of 5 years the overall survival, disease-free survival and event-free survival are 71%, 62% and 49.6% respectively. Toxicities were within the expected range. Conclusion: Our single-center experience real-world data in treating T-ALL/LBL-AYA patients with pediatric-inspired protocol demonstrates encouraging results of high survival rate and excellent tolerability for patients aged 18–55 years.

Background: primary graft failure is a devastating complication after allogeneic transplant. Donor specific antibodies has been reported as a major risk factor contributing to graft failure. We retrospectively analyzed our haploidentical transplant registry to report the incidence and impact of DSA and anti-HLA on engraftment in a cohort of malignant hematologic disease conditioned with myeloablative regimens. Methods: retrospective analysis of consecutive cases with malignant hematologic disorders who received a myeloablative haplo-HSCT at a single center. Results: 107 patients were identified with a median recipient age of 22 and a median donor age of 31. Sixty-two patients had AML (58%), 29 had ALL (27%), and 16 (15%) had other malignancies. Sixty-one recipients (57%) had positive anti-HLA, 56 of them had the DSA results available, of these 17 patients had DSAs (15% of the total number of patients, or 28% of patients who have anti-HLA antibodies). The median cumulative MFI was 2062 (IQR: 1038 - 6500). Sixty three percent of the DSA were against class II HLA antigens, while 37% were against class I HLA antigens. The OS, CIR, aGvHD, and cGvHD did not differ between patients with and without anti-HLA antibodies, nor between patients with and without DSA. The gender of the recipient and donor, as well as the gender mismatch between recipient and donor, were statistically associated with the incidence of anti-HLA antibodies, but not with DSA. Three patients only developed GF (2.8%), one was primary (0.9%) and the other two had secondary GF (1.9%). None of the GF cases was in patients with anti-HLA antibodies or DSA. Conclusion: In our cohort, the presence of anti-HLA or DSAs did not affect the outcomes including the incidence of PGF following myeloablative haplo-HSCT for malignant hematologic disorders.

Introduction: Several observational studies have found parallels between COVID-19 pneumonia and organizing pneumonia (OP). This study aims to investigate the published literature of OP related to COVID-19, estimates the prevalence of OP among COVID-19 patients, and assesses the risk or COVID-19 severity associated with OP. Methodology: This was a systematic review and meta-analysis. A systematic electronic search through PubMed, Web of Science, Science Direct, EBSCO, and Google Scholar was conducted to include relevant and eligible literature. The authors used Review Manager 5.4 to perform quantitative data synthesis for the condition of interest analyses. Results: A total of 9 eligible study articles and 12 case reports were included in this study. The estimated pooled organizing pneumonia prevalence among COVID-19 patients was 45.6% [23.1%-68.2%]. The association between OP and severe COVID-19 infection revealed a pooled OR [95% CI] of 5.22 [-0.96-11.41]. Conclusion: COVID-19 patients had a rather high OP prevalence (43%). Surprisingly, cancer patients with COVID-19 infection had the lowest OP prevalence. OP was identified as a possible risk factor for the severity of COVID-19 infection.

Emergency nurses are in the frontline in managing COVID-19 crises. Directly encountering and dealing with infected patients put nurses at high risk. To date, evidence about emergency nurses’ experiences of COVID-19, particularly those in the frontline, are limited. Understanding the experience and impact of the COVID-19 crisis on emergency nurses could contribute to improving nursing and disaster practices. This study aimed to explore the experiences of emergency nurses during their responses to the COVID-19 crisis. Thus, A cross-sectional design was used. For the data collection, a questionnaire was constructed and its validity and reliability was rigorously evaluated by principle component analysis (PCA), exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The data were collected in two phases, in which 111 and 128 emergency nurses were recruited from different hospitals in Saudi Arabia. The primary purpose of PCA; EFA and CFA to delete weak loading and extract and confirm factors. The findings of using factor analysis, of the 22 items, 11 items were retained with strong factor loadings (0.88 to 0.54) to three factors. The three factors were worry (4 items), compliance (4 items), and cautiousness (3 items). The reliability of the three factors was 0.84, 0.86, and 0.73, respectively, indicating that the scale had good reliability. The 11 scale items had robust psychometric properties, which implies that they could be used to evaluate emergency nurses’ experience in encountering and dealing with the COVID-19 crisis. Although nurses in the frontline showed compliance with infection control prevention measures, they were likely to experience certain degrees of fear and worry, which could lead to burnout. Hence, it is highly recommended to help nurses overcome such crises by providing consistent support and reassurance. Keywords: mmergency nursing; COVID-19; crisis; nursing care and experiences

Background Falls are ‎common occurrences events leading to ‎remarkable morbidity and ‎mortality. Vitamin D supplementation is often recommended to prevent falls, although vitamin D trials‎ conclude contradictory results. Aims This review aimed to summarize the available RCTs that studied the effect of ‎vitamin ‎D administered on falls in older adults. Methods Pub Med, ‎Google Scholar, and EBSCO ‎ databases were systematically search for relevant articles. The terms ‎ vitamin D, falls, ergocalciferols, 25-hydroxy vitamin D, and ‎‎1, ‎‎25-dihydroxy vitamin D‎ were used. out of Three hundred and four, only ‎eleven fulfilled ‎the inclusion criteria. Results In the majority of the randomized control trial, vitamin D supplementation provides protection against falls among the elderly population. Conclusion The majority of the studies concluded that vitamin D alone or ‎in ‎combination with calcium was a ‎successful fall ‎reduction method among the ‎elderly.

Background: Labor pain is a severe form of agony that females experience while giving birth. A lot of pregnant women prefer epidural anesthesia (EA) to avoid labor pain. Objective: This study focuses on women's general awareness about EA during the childbearing age. Methods: A cross-sectional, hospital-based study was conducted using a self-administered questionnaire. The study included all females of childbearing age getting routine antenatal care. The survey was designed to measure their awareness toward EA. A total of 328 females participated in the study. Of these, 205 (62.5%) women showed a low level of knowledge toward EA. Data were analyzed using the Chi-square test and Independent Samples t-test. Results: Participants in our study included 328 women of childbearing age. Most women (172 [52.4%]) participating in the study were aged between 30 and 40 years. In terms of education, 204 (62.2%) women had university-level education. Two hundred and ninety (88.4%) women were multipara. The majority of women (205 [62.5%]) had a low-level knowledge about EA with a significant relationship between the level of perception and primary education, as well as postgraduation with P < 0.023 and P < 0.001, respectively. Also, previous EA with pregnancy significantly related to the level of knowledge with P < 0.001. Through past pregnancies, 106 (32.3%) women had experience with EA. Of these, EA caused complications in only 13 (12.3%) women and side effects in 29 (27.4%) women. Conclusion: The majority of women of childbearing age had limited knowledge about the benefits and complications associated with EA. During the antenatal visit, it is essential to educate all women about EA. This could be done by the obstetrician, anesthesiologist, or midwives and/or through flyers and brochures.

Background: Proton pump inhibitors (PPIs) effectively suppress acid secretion and play an important role in peptic ulcer disease and gastroesophageal reflux disease. Physicians and pharmacists’ awareness and perception toward PPIs have a crucial role in regulating the use of PPI and preventing any adverse event, drug-drug interaction, or inappropriate use PPIs. Aim: The current study aims to assess proton pump inhibitors awareness level among physicians and pharmacists and its detriments in PHCCs, Aseer region, Saudi Arabia. Methods: An analytical cross-sectional study was applied to answer the main research question. The study targeted all physicians and pharmacists in primary healthcare centres in Abha who will be accessible during the study period from 23 May to 27 July. Data were collected from eligible participants using pre-structured online questionnaire. The questionnaire was developed by the researchers based on intensive literature review and expert’s consultation. The questionnaire covered participants’ personal data including age and gender, job title, and awareness items regarding PPI types, uses, side effects, and types. Results: A total of 178 participants completed the study questionnaire. 97 (54.5%) participants were pharmacists, 45 (25.3%) were clinical pharmacists, and 36 (20.2%) were physicians. Participants ages ranged from 20-40 years with mean age of 25.4 ± 9.7 years. 78.7% of the participants reported that PPIs are the 1st line pharmacological treatment for peptic ulcer which was insignificantly higher among clinical pharmacists (84.4%; P=.077). Omeprazole as the most prescribed PPI was known by 75.8% of the participants. As for Long-term use of PPI adverse reactions, 22.5% reported osteoporosis, 20.2% selected vitamin B12 deficiency, 2.2% reported pneumonia, while 55.1% selected all options, especially pharmacists and clinical pharmacists (60.8% and 60%, respectively; P=.017). Conclusion and Recommendations: In conclusion, the current study showed that medical staff in the primary healthcare centres had moderately low knowledge regarding PPI and its indications. The lowest awareness was mainly among physicians relative to pharmacists especially clinical pharmacists. Key words: Proton pump inhibitors, awareness, practice, medical staff, pharmacist, physician, knowledge

The effect of extracting solvents used by two methods on the TPC, TFC, antioxidant as well as lipoxygenase, and tyrosinase inhibition activities of

This research has dealt with radiological and radio-therapeutic data from two challenging skull base tumours, namely, skull base chordoma and large vestibular schwannoma, aiming to assess the safety and efficacy of the current practices. The focus of this research was on the management of these tumours in combination with the recommended types of radiation therapy, proton therapy, and Gamma Knife radiosurgery. The study also contributed to filling some of the knowledge gaps present in imaging the facial nerve and radiation dose planning, which would have a positive impact on the current practices or provide opportunity for further exploration or improvement of current methods.

BACKGROUND: On March 2, 2020, Saudi Arabia identified the first positive COVID-19 case. Since then, several aspects of the COVID-19 impact on Emergency Departments (EDs) use have been reported. The objective of this study is to describe the pattern and characteristics of Emergency Department visits during the COVID-19 pandemic period, compared with the same period in the previous year, including the patients' demographic information, acuity level, length of stay, and admission rate.METHODS: Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia. The health records of all the patients who presented at the Emergency Department from January 2019 to September 2020 were retrospectively reviewed. The variations in the patient and the visit characteristics were described for the periods before and during COVID-19.RESULTS: The records of 209,954 patients who presented at the Emergency Department were retrieved. In contrast to 2019, the number of visits during the pandemic period reduced by 23%. A dramatic decrease was observed after the announcement of the first COVID-19 diagnosed case in Saudi Arabia, and subsequently the numbers gradually increased. The patients who presented at the Emergency Department during the pandemic period were slightly older (mean age, 43.1 versus 44.0 years), more likely to be older, more urgent and had a higher admission rate compared to the pre-pandemic period. There was a slight increase in visits during the daytime curfew hours and a decrease during the nighttime.CONCLUSION: We report a considerable decrease in the number of Emergency Department visits. The reduction was higher in non-urgent and less urgent cases. Patients presenting at the Emergency Department during the curfew times were more likely to stay longer in the Emergency Department and more likely to be admitted, compared with the pre-pandemic period.

Duaa Brinjee,1 Abdulellah Al Thobaity,2 Mohammed Almalki,2 Waleed Alahmari2 1Nursing Department, Al Noor Hospital, Makkah, Makkah Region, Saudi Arabia; 2Nursing Department, Applied Medical Sciences, Taif University, Taif, Makkah Region, Saudi ArabiaCorrespondence: Abdulellah Al ThobaityNursing Department, Applied Medical Sciences, Taif University, Taif, Saudi ArabiaEmail a.thobaity@tu.edu.saIntroduction: Nursing is considered the healthcare profession with the most members. Emergency nurses constitute the first line of treatment in healthcare facilities when catastrophic events bring disaster victims in need of medical attention. Therefore, these nurses must be well educated and trained efficiently to be able to deal with disastrous situations properly. This study aimed to distinguish the most important elements of education and training for preparing emergency nurses to face disasters in the Kingdom of Saudi Arabia (KSA), specifically, the city of Taif.Methods: This study employed a tool to measure nurses’ most important training and education needs that was created by the authors based on a literature review and was approved by an expert panel in disaster nursing. Questionnaires were distributed to emergency nurses in four hospitals run by the Ministry of Health in Taif city. Survey responses were received from 210 participants, and the data were analyzed using a principal component analysis (PCA). A one-way ANOVA was used to determine the differences between groups according to their experiences.Results: The following three factors were extracted from the data after redundant items were loaded and excluded: incident management systems (IMSs), disaster triage, and disaster drills. Nurses with less than three years of experience have a significant need to learn about these elements in order to be able to cope with disasters.Conclusion: Understanding different types of disasters and how to deal with these catastrophic events is crucial. Significant differences existed between ED nurses in their understanding of the basic elements of disaster management based on their level of experience in an ED. Therefore, disaster education must be included in nursing curricula, and more training courses, mock drills, and simulations must be conducted in hospitals for nurses, especially nurses with less experience, so they can learn to manage their responsibilities during disasters.Keywords: disaster nursing, disaster education, disaster training, disaster preparedness

Mohammed Al Dubayee,1– 3 Awad Alshahrani,1– 3 Dana Aljada,4 Mahmoud Zahra,5 Ahmed Alotaibi,1 Ibrahim Ababtain,1 Malik Alnaim,1 Ali Alahmari,1 Abdullah Aljarallah,1 Muhammad Affan Elahi,5 Hana MA Fakhoury5 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; 3Department of Medicine, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia; 4College of Liberal Arts and Sciences, Hofstra University, Hempstead, NY, USA; 5Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi ArabiaCorrespondence: Mohammed Al DubayeeCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), P.O. Box 22490, Riyadh, Saudi ArabiaTel +966 11 801 1111 ext: 53551Email ALDUBAYEEMO@ngha.med.saIntroduction: Insulin resistance in obesity and type 2 diabetes mellitus (T2DM) is associated with cardiovascular complications such as atherosclerosis. On the other hand, the reduction of apoptosis in macrophages has been linked with accelerated atherosclerosis. Apoptosis is controlled by a different family of proteins including Bcl-2 and caspases.Methods: To examine apoptosis in insulin resistance, we assessed the mRNA expression by qRT-PCR of several Bcl-2 family members, as well as caspase-3, − 7, − 8, and − 9 in peripheral blood mononuclear cells (PBMCs) isolated from lean, obese, diabetic, and diabetic on metformin individuals.Results: PBMCs of diabetic individuals exhibited reduced expression of caspase-7 and increased expression of Bcl-10, Bad, Bax, Bid, and caspase-3. T2DM on metformin group had significantly higher Bad, Bax, and caspase-7 expression.Discussion: The moderate up-regulation of pro-apoptotic Bcl-10, Bax, Bad, Bid, and the effector caspase-3 coupled with inhibition of caspase-7 in circulating PBMCs of T2DM could be the result of increased inflammation in T2DM. Metformin treatment significantly inhibited the expression of Bcl-10, Bid, and caspase-3 and upregulated Bad/Bax/caspase-7 pathway suggesting the activation of Bad/Bax/caspase-7 apoptotic pathway. Further studies are warranted to elicit the underlying apoptotic pathways of PBMCs in T2DM and following metformin treatment.Keywords: apoptosis, T2DM, peripheral blood mononuclear cells, PBMC, caspase, BCl-10, BCl-2

Aplastic anemia is a relatively rare but potentially fatal disorder, with a reported higher incidence in developing countries in comparison to the West. There are significant variations in epidemiological as well as etiological factors of bone marrow failure syndromes in the developing countries in comparison to the developed world. Furthermore, the management of bone marrow failure syndromes in resource constraint settings has significant challenges including delayed diagnosis and referral, limited accessibility to healthcare facilities, treatment modalities as well as limitations related to patients who require allogeneic stem cell transplantation. Here we will provide a review of the available evidence related to specific issues of aplastic anemia in the developing countries and we summarize suggested recommendations from the Eastern Mediterranean blood and bone marrow transplantation (EMBMT) group and the severe aplastic anemia working party of the European Society of blood and marrow transplantation (SAAWP of EBMT) related to the diagnosis and therapeutic options in countries with restricted resources.

e-Learning can generally be applied by employ-ing learning management system (LMS) platforms designed to support an instructor to develop, manage, and provide online courses to learners. During the COVID-19 pandemic, several LMS platforms were adopted in Saudi Arabian institutions, such as Moodle and Blackboard. However, in order to adopt e-learning and operate LMS platforms, there is a need to investigate factors that influence the capability of faculty to utilize e-learning and its perceived benefits on students. This paper examines how training support and LMS readiness factors influence the capability of faculty to adopt e-learning and student perceived benefits. A quantitative research method was conducted using an online questionnaire survey method. Research data was collected from 274 faculty members, who used Moodle as a main LMS platform, at Shaqra University in the Kingdom of Saudi Arabia (KSA). The results reveal that training support and LMS readiness have a positive influence on the faculty’s capability to adopt e-learning, which leads to enhancing students’ perceived benefits. By identifying the factors that influence e-learning adoption, universities can provide enhanced e-learning services to students and support faculty through providing adequate training and powerful e-learning platform.

ObjectivesChemical, biological, radiological, and nuclear (CBRN) incidents are those that involve chemical or biological warfare agents or toxic radiological or nuclear materials. These agents can cause disasters intentionally or accidentally. Hospitals play a crucial role in handling CBRN disasters. This study aimed to assess the CBRN preparedness of government hospitals in Riyadh.MethodsA descriptive cross-sectional study was conducted across government hospitals in Riyadh, all government hospitals in Riyadh with more than 100 inpatient beds and an emergency department met the inclusion criteria. Hospital preparedness was assessed using an adaptation of the CBRNE Plan Checklist. Results were described in frequencies across several domains such as foundational considerations, planning, training and awareness, procedures, and modules for preparing for a biological incident, a chemical incident, and a radiological or nuclear incident.ResultsOf the 11 eligible hospitals, 10 participated in the study. Further, CBRN considerations were included in the disaster plans of 7 hospitals. Drills had been conducted in collaboration with local agencies in only 2 hospitals. The staff had been trained to recognize the signs and symptoms of exposure to class (A) biological agents in less than half of the hospitals. A majority of the hospitals had antidotes and prophylactics to manage chemical incidents, but only half of them had radiation detection instruments. Personal protective equipment was available in all hospitals, but rapid access to stockpiles of medications was available in only half of them.ConclusionGovernment hospitals in Riyadh demonstrated insufficient CBRN preparedness. Therefore, their staffs should be trained to manage CBRN emergencies, and local drills should be conducted to improve their preparedness.

Overcrowding in Emergency Department usually results in serious consequences such as delay in facilities, medical errors and medical complications as well. This occurs because delay in transfer of the patients from ED to inpatient departments. We conducted this study to know patients’ and their attendants preferences to stay in ED or to be shifted to in-patient units. Data was collected via Arabic translated questioner. A total of 316 applicants included in the study (after inclusion / exclusion criteria), 144 patients with 157 patient attendants. 75 (52.1%) were male, while 69 (47.9%) were females. The preferred area for boarding was ED curtained space for 77.8% of patients and 79% of patient watcher as compared to 11.8% patients and 15.3% attendants who accepted the admission to inpatient hallway (p- value 0.253). Regarding the comparison of boarding time (8 hours and 24 hours), 55.5% of patients preferred in ED with 8 hours scenario versus 29.9% who preferred inpatient hallway (p=0.0897). When 24 hours scenario was compared, it was found that 59% patients preferred ED while 49.7% preferred inpatient hallway (p= 0.252). Current study proves that collectively patients prefer to stay in ED (either curtained space or hallway); this is because the patients received quick facilities and attention from the staff. However, with 24 hours scenario, more patients now preferred to stay in in-patient hallway; this is because of delay in transfer of the patients from ED, and delay or lack in facilities which usually occur during overcrowding. We concluded that patient and their preferences differ in different settings. However, overcrowding in ED should be dealt seriously with transfer of patients to in-patient departments / wards as soon as possible to avoid medical errors and complications.