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Shaherah Yousef Andargeery,1 Abdullah Ahmed Almalki,2,3 Nada Aljohani,4 Hanan Alyami,3,4 Abdulrhman Alhagbani3,5 1Nursing Management and Education Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2King Abdulaziz General Hospital, Makkah Healthcare Cluster, Makkah, Saudi Arabia; 3Saudi Patient Experience Club, Saudi Society for Health Administration, Riyadh, Saudi Arabia; 4Department of Medical and Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 5Riyadh First Health Cluster, Riyadh, Saudi ArabiaCorrespondence: Shaherah Yousef Andargeery, Nursing Management and Education Department, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Email syandargeery@pnu.edu.saBackground: Many patients experience stress and dissatisfaction when they are admitted to acute settings, where they receive short-term and active care for severe injuries, illnesses, or surgeries. Patient satisfaction is a key indicator of healthcare quality that affects patient outcomes, service delivery, and safety.Objective: This review aimed at systematically mapping and summarizing the evidence on non-pharmacological interventions that targeted patient satisfaction in inpatient acute settings.Methods: Three electronic databases were searched, including PubMed, EBSCO, and ScienceDirect. The inclusion criteria were: (1) studies of non-pharmacological interventions to improve patients’ satisfaction and targeting inpatients between the ages of 19 and 65 years old; (2) studies written in English and published in the last 10 years, starting from 2017. The search results were imported and screened for eligibility on Covidence. The data was then extracted, using a tool entered in Covidence’s Extraction 2.0. The extraction tool included domains on both intervention impact and delivery processes.Results: A total of 11 articles met the inclusion criteria. Randomized control trials represented the most among the group; seven studies were included given that the others were quasi-experimental studies. Those studies were conducted on the different types of services offered in acute care departments. These studies did not use a standardized questionnaire to evaluate their respective trial outcomes or to implement various adapted or adopted modules of intervention. Of note, the intervention was effective in enhancing patient satisfaction in only some of the studies.Conclusion: Different types of intervention modules have been effective in improving acute care patient satisfaction. However, further studies are needed to evaluate the effectiveness of an intervention among all patients in different acute care departments at the same time.Keywords: inpatient satisfaction, nonpharmacological interventions, systematic review, acute care, acute settings

Nadia Ghannam,1 Saleh Alahmed,2 Raed Aldahash,3 Naji Aljohani,4 Afaf Alshammary,5 Ashraf Amir,6 Abdullah Kamal,7 Said Khader,8 Mohammed Salah,9 Hani Shalabi,10,11 Ahmed Abdallah,12 Ahmed Elboghdady12 1Ghannam Clinic, Jeddah, Saudi Arabia; 2Almana Group of Hospitals, Dammam, Saudi Arabia; 3Ministry of National Guard (Health Affairs) and King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 4King Fahad Medical City, Riyadh, Saudi Arabia; 5Ministry of National Guard (Health Affairs), King Abdulaziz Medical City, Riyadh and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 6Family Medicine International Medical Center, Jeddah, Saudi Arabia; 7Dallah Hospital, Riyadh, Saudi Arabia; 8Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; 9Cairo University, Cairo, Egypt and GNP Hospital, Jeddah, Saudi Arabia; 10University of Jeddah, Jeddah, Saudi Arabia; 11Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia; 12Merck Serono Middle East FZ-Ltd, Jeddah, Saudi ArabiaCorrespondence: Nadia Ghannam, Ghannam Clinic, King Abdulaziz Road, Jeddah, 21411, Saudi Arabia, Email ghannam_clinic@yahoo.comAbstract: The onset of type 2 diabetes increases the risk of vascular complications and death. We know now that that this risk begins long before the diabetes diagnosis. Prediabetes and type 2 diabetes are not separate entities in practice and exist within a continuum of dysglycaemia and vascular risk that increases in severity over time. This excess risk requires early intervention with lifestyle therapy supported with pharmacologic antidiabetic therapy, intensified promptly where necessary throughout the duration of the diabetes continuum. Metformin is an evidence-based treatment for preventing prediabetes and improves cardiovascular outcomes in people with type 2 diabetes from diagnosis onwards. Newer agents (SGLT2 inhibitors and GLP-1 agonists) are appropriate for people presenting with type 2 diabetes and significant cardiovascular comorbidity. Additional therapies should be used without delay to achieve patients’ individualised HbA1c goals and to minimise cardiovascular risk.Keywords: prediabetes, type 2 diabetes, diabetes complications, antidiabetic therapy

The Kingdom of Saudi Arabia obtains the most desalination water from the Red Sea. In Saudi Arabia, 14 desalination plants receive water from the Red Sea, and three are located in the country’s east and rely on the Arabian Gulf. The study has observed 16 desalination plants out of 17 desalination plants in the kingdom. Most of the desalination plants in Saudi Arabia currently use the advanced technologies to produce potable water with less impact on the surrounding environment. The current study examined the variation of hydrographic parameters along all available desalination plants in Saudi Arabia. This is the first inter-annual database of hydrographic parameters in the last 4 years. The peak salinity was measured at the Duba desalination plant in 2020, and it was 67.2 ppt. During 2018, the Azizia desalination plant reported the lowest value of 36.8 ppt. The maximum temperature recorded at the Qunfudah desalination plant in 2019 was 34.6°C. In 2017, the minimum temperature was 19.1°C at the Jubail desalination plant. The level of dissolved oxygen and pH were likewise not significantly changed along the brine outflow and in the outfall, in contrast to temperature and salinity. On the basis of 4 years’ of data from observed desalination facilities, the current study sheds light on the less environmental impact with regard to hydrographic factors.

Khalid Hussain AL-Qahtani,1 Mutahir A Tunio,2 Mushabbab Al Asiri,2 Yasser Bayoumi,3 Ali Balbaid,2 Naji J Aljohani,4 Hanadi Fatani5 1Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia; 3Department of Radiation Oncology, NCI, Cairo University, Cairo, Egypt; 4Department of Endocrinology and Thyroid Oncology, 5Histopathology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia Introduction: The aim of this study was to evaluate the treatment outcomes of differentiated thyroid cancer in Saudi patients aged above 60 years. Materials and methods: Comparative analysis was performed in 252 patients aged 46–60 years (Group A) and 118 patients aged above 60 years (Group B), who had thyroidectomy, radioactive iodine-131, and thyroid-stimulating hormone suppression therapy between July 2000 and December 2012. Different clinicopathological features, treatment, complications, disease-free survival, and overall survival rates were compared. Results: Mean age of patients in Group A was 51.9 years (range: 46–60), and mean age of those in Group B was 68.6 years (range: 62–97). Group B patients had higher positive lymph nodes (43.2%), P=0.011. The frequency of extrathyroidal extension, multifocality, and lymphovascular space invasion was seen more in Group B than in Group A. Postsurgical complications (permanent hypoparathyroidism, bleeding, and wound infections) were also seen more in Group B (P=0.043, P=0.011, and P=0.021, respectively). Group B patients experienced more locoregional recurrences (11.0%, P=0.025); similarly, more distant metastases were observed in Group B (15.3%, P=0.003). The 10-year disease-free survival rates were 87.6% in Group A and 70.8% in Group B (P

Khalid Hussain Al-Qahtani,1 Mushabbab Al Asiri,2 Mutahir A Tunio,2 Naji J Aljohani,3 Yasser Bayoumi,4 Iqbal Munir,5 Ayman AlAyoubi6 1Department of Otolaryngology – Head and Neck Surgery, College of Medicine, Advanced Head and Neck Oncology, King Saud University, 2Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, 3Endocrinology and Thyroid Oncology, King Fahad Medical City, Riyadh, Saudi Arabia; 4Radiation Oncology, NCI, Cairo University, Cairo, Egypt; 5Nuclear Medicine Sulaiman Al-Habib Hospital, 6Clinical Ophthalmology, King Fahad Medical City, Riyadh, Saudi Arabia Background: Radioactive iodine 131 (131I) therapy has long been used in the treatment of differentiated thyroid cancers (DTC). While salivary and lacrimal glandular complications secondary to 131I therapy are well documented, there is little in the literature addressing nasolacrimal duct obstruction (NLDO). We aimed to evaluate the frequency of 131I therapy-acquired NLDO, its correlation to 131I therapy doses, and the surgical treatment outcome of this rare side effect.Methods: From 2000–2012, a retrospective review of 864 among 1,192 patients with confirmed DTC who were treated with 131I therapy was performed to examine the frequency of NLDO, its causative factors, as well as imaging, surgical intervention, and outcomes.Results: Nineteen (2.2%) patients were identified with NLDO. The mean age was 51.9±10.5 years (range: 39–72 years). Fifteen (78.9%) were female and four were male (21.1%). The mean individual 131I doses were 311.1±169.3 millicurie (mCi) (range: 150–600 mCi). The mean duration between the date of 131I therapy and the occurrence of NLDO was 11.6±4.1 months (range: 6.5–20). Fourteen (73.7%) patients had bilateral epiphora. Computed tomography dacryography allowed for the detection of all NLDO. Eighteen (94.7%) patients underwent dacryocystorhinostomy. Complete recovery was obtained in 14 (73.7%) patients. Age >45 years and 131I therapy doses >150 mCi were significantly correlated with NLDO (P=0.02 and P=0.03, respectively).Conclusion: NLDO is an underestimated complication of 131I therapy in DTC patients. Clinicians should be aware of this rare complication for prompt intervention. Keywords: nasolacrimal duct obstruction, radioactive iodine 131 therapy, differentiated thyroid cancers

Naif I AlJohani,1,2 John H Matthews2 1King Faisal specialist hospital and research centre, Saudi Arabia; 2Division of Hematology, Department of Internal Medicine, Queen's University, Kingston, Ontario, Canada Abstract: Acquired factor V inhibitor is a rare hemostatic disorder that presents with hemorrhagic manifestations in the vast majority of patients. Factor V inhibitor may develop through a variety of mechanisms involving development of alloantibodies or autoantibodies specific to Factor V. Autoantibodies, in particular, have been reported in a number of conditions. In this report, we describe a case of acquired factor V inhibitor in a patient with mantle cell lymphoma who presented with hematuria. Seven weeks after diagnosis and successful management, the patient developed deep vein thrombosis in the right lower extremity. The patient's factor V levels were normalized, and the inhibitor was successfully eradicated using corticosteroids. Here, we discuss this rare disorder, its unusual manifestation, and provide a mini-review of the current literature regarding factor V inhibitors. Keywords: acquired factor V inhibitor, blood coagulation disorders, factor V deficiency, acquired bleeding disorders

Optical character recognition (OCR) is vital in digitizing printed data into a digital format, which can be conveniently used for various purposes. A significant amount of work has been done in OCR for well-resourced languages like English. However, languages like Urdu, spoken by a large community, face limitations in OCR due to a lack of resources and the complexity and diversity of handwritten scripts. One of the major hindrances in the development of OCR for low-resource languages like Urdu is the lack of extensive datasets. However, such datasets can be obtained from old handwritten books with reference text available online. This study presents a method to leverage this resource and automatically process Urdu handwritten poetry books with corresponding scripts available online. The images are segmented at the sentence level using automated neighborhood-connected component analysis, followed by manual adjustment. Corresponding Unicode text for each image are obtained by web scraping followed by text similarity analysis. A sample dataset collected comprises purely handwritten Urdu text images for Urdu poetry by Mirza Ghalib and Allama Iqbal, arguably the two most influential poets in Urdu. The dataset comprises 2888 images with Unicode transcriptions from poetry by Mirza Ghalib and Allama Iqbal.•The method automates OCR dataset creation by segmenting handwritten text images and scraping corresponding text from the web for alignment.•Handwritten images are segmented into sentences using a resource-efficient Neighborhood Component Analysis approach.•Possible text samples are scraped from the web, and the corresponding labels are aligned with images based on the minimum edit distance between the scraped text and the predictions by an OCR engine., 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., (© 2024 The Author(s).)

Background: Blood donation plays a critical role in public health, yet long-term donors (donating at least twice per year, for at least three years) often face challenges related to psychological adjustment and quality of life. Digital health tools could offer innovative solutions to address these issues by providing personalized support, tracking, and mental health interventions., Aim: This study investigates the impact of digital health tools on the quality of life (QoL) and psychological adjustment of long-term blood donors in Saudi Arabia, with attention to demographic factors influencing engagement and perceptions., Methods: A cross-sectional survey was conducted among 498 long-term blood donors aged 18-60, recruited from blood donation centers across Saudi Arabia. Participants were recruited through social media platforms, university networks, and professional organizations to ensure a diverse sample in terms of background, long-term donation history (more than 10 times), and daily digital usage habits. Participants completed an online questionnaire incorporating the WHO Quality of Life-Brief Version (WHOQOL-BREF) and Coping Orientation to Problems Experienced Inventory (Brief-COPE) inventory to assess QoL and coping mechanisms. Descriptive statistics, two-sample t-tests, and ANOVA analyses were performed to examine differences in perceptions based on age, gender, and educational level., Results: The findings indicate a generally positive perception of digital health tools, with mean QoL scores for self-distraction (Mean ± SD: 3.33 ± 0.97), active coping (3.29 ± 0.97), and psychological well-being (3.31 ± 0.82). Significant differences were observed across age groups, with older participants reporting higher perceived benefits ( p < .0001). Gender differences were also significant, with females showing higher mean scores in psychological adjustment factors such as active coping (3.75 ± 0.62) compared to males (2.8 ± 0.81), p < .0001., Conclusion: Digital health tools are perceived as beneficial for supporting QoL and psychological adjustment among blood donors, particularly for emotional and health management. Demographic factors such as age, gender, and education play a significant role in shaping these perceptions, highlighting the need for tailored interventions. Further research should explore longitudinal impacts to inform the design of more effective, culturally aligned digital health solutions for donor support., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Research Ethics Committee at Imam Abdulrahman Bin Faisal University issued approval IRB-2024-03-606. 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, Alanzi et al.)

Brain tumors are a leading cause of death globally, with numerous types varying in malignancy, and only 12% of adults diagnosed with brain cancer survive beyond five years. This research introduces a hyperparametric convolutional neural network (CNN) model to identify brain tumors, with significant practical implications. By fine-tuning the hyperparameters of the CNN model, we optimize feature extraction and systematically reduce model complexity, thereby enhancing the accuracy of brain tumor diagnosis. The critical hyperparameters include batch size, layer counts, learning rate, activation functions, pooling strategies, padding, and filter size. The hyperparameter-tuned CNN model was trained on three different brain MRI datasets available at Kaggle, producing outstanding performance scores, with an average value of 97% for accuracy, precision, recall, and F1-score. Our optimized model is effective, as demonstrated by our methodical comparisons with state-of-the-art approaches. Our hyperparameter modifications enhanced the model performance and strengthened its capacity for generalization, giving medical practitioners a more accurate and effective tool for making crucial judgments regarding brain tumor diagnosis. Our model is a significant step in the right direction toward trustworthy and accurate medical diagnosis, with practical implications for improving patient outcomes.

Thyrotoxic crisis (thyroid storm) is a severe form of hyperthyroidism. It has a wide range of symptoms, including cardiovascular manifestations that can be life-threatening and require prompt management. Cardiac manifestations of thyroid storm include hypertension, tachycardia, congestive heart failure, cardiac ischemia, and atrial fibrillation. Standard therapeutic approaches of thyroid storm are based on the use of thionamides, corticosteroids, and nonselective beta-blockers to inhibit thyroid hormone synthesis and release while also blocking thyroxin's peripheral effects. This approach is an effective measure in the management of these manifestations. However, when a patient fails to respond to conventional therapy, or there is end organ damage and surgery is not feasible, therapeutic plasma exchange (TPE) is a life-saving measure. Here, we report a case of a 27-year-old female who is known to have hyperthyroidism, but she was not compliant with her medication. She presented with symptoms of hyperthyroidism and was found to have a thyroid storm with refractory atrial fibrillation. Despite the effort to control her symptoms, she developed cardiac arrest, and after 15 minutes of cardiopulmonary resuscitation, she was revived. Amiodarone, beta-blockers, and cardioversion failed to improve the patient's status, and her condition deteriorated. So, we decided to use TPE, and she received three sessions in total. After the first session of TPE, her rhythm converted to sinus rhythm, and her heart rate was controlled to less than 100 beats per minute. She showed dramatic improvement clinically and biochemically. In conclusion, cardiac complications are potentially lethal complications of thyroid storm. Prompt restoration of a normal thyroid state can reverse these complications. When conventional therapy fails to ameliorate symptoms or organ deterioration is rapid and severe, TPE can be a safe and effective measure., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, AlShehri et al.)

Aim: This cross-sectional study aims to identify and quantify the factors influencing Saudi medical residents in selecting their desired specialty and primary training center, while examining the associations between these factors., Methods: The study received approval from an institutional ethical committee at King Abdulaziz University. An electronic questionnaire was designed and validated via content, face validity, and the Content Validity Index. The sample size was calculated based on a 95% CI and a 5% margin of error. The study targeted all current residents in the current Saudi Specialty Certificate Programs. Descriptive statistics summarized demographic characteristics, training-related information, and factors influencing the selection of a specialty and training center. Fisher's exact test and Chi-square tests were employed for data analysis., Results: A total of 387 respondents completed the survey, with a 32.3% response rate. The majority of respondents were male (n = 232, 59.9%), and the majority were also married (n = 67.2%), with internal medicine (n = 92, 23.8%) and family medicine (n = 74, 19.1%) being the most prevalent specialties. Notably, 89.4% (n = 346) reported matching into their first-choice specialty, and 67.2% (n = 260) into their first-choice training center. Furthermore, 90.2% (n = 349) had prior training (elective/internship) in their chosen specialty, and 63% (n = 244) had previous training (elective/internship) at their primary training center. Prior exposure to both specialty and center significantly resulted in them being the resident's top choice (p < 0.01). Multiple factors influencing the choice of either the specialty or the center were found to have statistically significant associations with the gender, specialty, residency level, sector of the training center, and timing of the specialty decision (p < 0.05)., Conclusion: This study reveals the substantial influence of early experiences on Saudi medical residents' specialty and training center choices. It also uncovers gender disparities and variations in the influence of specialty-related factors. Future research with larger and more diverse samples is recommended to gain a deeper understanding of the multifactorial decision-making processes, enabling the development of strategies to better meet the evolving needs and preferences of healthcare professionals in Saudi Arabia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sindi et al.)

Background: Dietary intake is widely known to play a crucial role in achieving peak bone mass among children and adolescents. Unfortunately, this information is lacking among Arab adolescents, an understudied demographic that has recently been observed to have a high prevalence of abnormal mineralization markers [low serum 25(OH)D, high serum alkaline phosphatase (ALP), low calcium (Ca) and/or inorganic phosphate (Pi)] suggestive of biochemical osteomalacia (OM, defined as any 2 of the 4 parameters). In order to fill this gap, we aimed to evaluate the associations of serum markers of biochemical OM with dietary intake of macronutrients, vitamins and trace minerals., Methods: Saudi adolescents ( N  = 2,938, 57.8% girls), aged 12-17 years from 60 different schools in Riyadh, Saudi Arabia were included. Dietary intake of nutrients was calculated following a semi-quantitative 24 h dietary recall over 3 weekdays and 1 weekend-day using a validated food frequency questionnaire. Compliance to reference daily intake (RDI) of macronutrients, vitamins and trace minerals were calculated. Fasting blood samples were collected and circulating levels of 25(OH)D, ALP, Ca, and Pi were analyzed., Results: A total of 1819 (1,083 girls and 736 boys) adolescents provided the dietary recall data. Biochemical OM was identified in 175 (9.6%) participants (13.5% in girls, 3.9% in boys, p  < 0.01) while the rest served as controls ( N  = 1,644). All participants had serum 25(OH)D levels <50 nmoL/L. Most participants had very low dietary intakes of Ca (median ~ 290 mg) and vitamin D (median ~ 4 μg) which are far below the RDI of 1,300 mg/day and 20 μg/day, respectively. In contrast, excess dietary intakes of Pi, Na, K, and Fe were observed in all participants. In the biochemical OM group, thiamine and protein intake were significant predictors of serum 25(OH)D, explaining 4.3% of the variance perceived ( r  = 0.23, adjusted r 2  = 4.3%, p  = 0.01). Among controls, dietary vitamin C and vitamin D explained 0.6% of the total variation in serum 25(OH)D ( r  = 0.09, adjusted r 2  = 0.6%, p  = 0.004)., Conclusion: Arab adolescents do not meet the RDI for dietary Ca and vitamin D, and none have sufficient vitamin D status (25(OH)D levels >50 nmol/L) but they exceed the RDI for dietary Pi. Interpreting these data in the light of the increased prevalence of rickets in Arab countries, food fortification to optimise vitamin D and Ca intake in Saudi adolescents should be considered., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Al-Daghri, Sabico, Wani, Hussain, Yakout, Aljohani, Uday and Högler.)

Background and Aims: The DaR Global survey was conducted to observe the impact of the COVID-19 pandemic on the intentions to fast and the outcomes of fasting in people with diabetes and chronic kidney disease (CKD)., Methods: Muslim people with diabetes and CKD were surveyed in 13 countries shortly after the end of Ramadan 2020, using a simple Survey Monkey questionnaire., Results: This survey recruited 6736 people with diabetes, of which 707 (10.49%) had CKD. There were 118 (16.69%) people with type1 diabetes (T1D), and 589 (83.31%) were with type2 diabetes (T2D). 62 (65.24%) people with T1D and 448 (76.06%) people with T2D had fasted with CKD. Episodes of hypoglycaemia and hyperglycaemia were more frequent among people with T1D compared to T2D, 64.52% and 43.54% vs 25.22% and 22.32% respectively. Visits to the emergency department and hospitalization were more frequent among people with CKD, however no significant difference was found between people with T1D and T2D., Conclusion: The COVID-19 pandemic had only a minor effect on the intention to fast during Ramadan in people with diabetes and CKD. However, hypoglycaemia and hyperglycaemia were found to be more frequent, as well as emergency visits and hospital admissions among people with diabetic kidney disease. Prospective studies are needed in future to evaluate the risk indicators of hypoglycaemia and hyperglycaemia among fasting people with CKD, especially in the context of different stages of kidney disease., Competing Interests: Declaration of competing interest There is no declaration of interest or conflict of interest., (Copyright © 2023 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Osteoporosis is a major public health concern in Saudi Arabia's aging population. There is particularly limited information on how diet affects bone loss in this ethnic group. The purpose of this study was to examine the association between dietary calcium (Ca) intake and osteoporosis risk in Saudi adults. A total of 1950 patients (416 males and 1534 females) with known risk factors for osteoporosis participated in this cross-sectional study. A short questionnaire (CaQ) was used to assess dietary Ca intakes in patients attending tertiary hospitals in Riyadh City. The prevalence of osteoporosis was 21.3% and was more common in females (93.5%). Patients with osteoporosis were older ( p < 0.001) and had lower BMI ( p < 0.001). Results showed that the overall mean Ca intake was only 445.1 mg/day (recommended dietary intake of 1300 mg/day). Tea intake (OR = 0.8 95%CI: 0.7-1.0; p = 0.02) and consumption of fish and eggs (OR = 0.9 95%CI: 0.8-1.0; p = 0.01) were significantly associated with a lower risk of osteoporosis. Furthermore, consumption of biscuits, cake and bread slices were significantly associated with higher incidence of osteoporosis (OR = 1.3 95%CI: 1.0-1.5; p = 0.02). In conclusion, extremely low dietary Ca intake was observed among Saudi adults already at risk of osteoporosis. A balanced diet including high amount of Ca, vitamin D and omega-3 fatty acids accompanied by limiting consumption of foods high in saturated fats and glycemic index may be helpful in reducing osteoporosis risk in the Saudi adult population.

Family history is an important factor in determining hereditary cancer risk for many cancer types. The emergence of next-generation sequencing (NGS) has expedited the discovery of many hereditary cancer susceptibility genes and the development of rapid, affordable testing kits. Here, a 30-gene targeted NGS panel for hereditary cancer risk assessment was tested and validated in a Saudi Arabian population. A total of 310 subjects were screened, including 57 non-cancer patients, 110 index patients with cancer and 143 of the cancer patients' family members, 16 of which also had cancer. Of the 310 subjects, 119 (38.4%) were carriers of pathogenic or likely pathogenic variants (PVs) affecting one or more of the following genes: TP53, ATM, CHEK2, CDH1, CDKN2A, BRCA1, BRCA2, PALB2, BRIP1, RAD51D, APC, MLH1, MSH2, MSH6, PMS2, PTEN, NBN/NBS1 and MUTYH . Among 126 patients and relatives with a history of cancer, 49 (38.9%) were carriers of PVs or likely PVs. Two variants in particular were significantly associated with the occurrence of a specific cancer in this population (APC c.3920T>A - colorectal cancer/Lynch syndrome ( p = 0.026); TP53 c.868C>T; - multiple colon polyposis ( p = 0.048)). Diverse variants in BRCA2, the majority of which have not previously been reported as pathogenic, were found at higher frequency in those with a history of cancer than in the general patient population. There was a higher background prevalence of genetic variants linked to familial cancers in this cohort than expected based on prevalence in other populations.

Learning analytics (LA) has gained increasing attention for its potential to improve different educational aspects (e.g., students' performance and teaching practice). The existing literature identified some factors that are associated with the adoption of LA in higher education, such as stakeholder engagement and transparency in data use. The broad literature on information systems also emphasizes the importance of trust as a critical predictor of technology adoption. However, the extent to which trust plays a role in the adoption of LA in higher education has not been examined in detail in previous research. To fill this literature gap, we conducted a mixed method (survey and interviews) study aimed to explore how much teaching staff trust LA stakeholders (e.g., higher education institutions or third-parties) and LA technology, as well as the trust factors that could hinder or enable adoption of LA. The findings show that the teaching staff had a high level of trust in the competence of higher education institutions and the usefulness of LA; however, the teaching staff had a low level of trust in third parties that are involved in LA (e.g., external technology vendors) in terms of handling privacy and ethics-related issues. They also had a low level of trust in data accuracy due to issues such as outdated data and lack of data governance. The findings have strategic implications for institutional leaders and third parties in the adoption of LA by providing recommendations to increase trust, such as, improving data accuracy, developing policies for data sharing and ownership, enhancing the consent-seeking process, and establishing data governance guidelines. Therefore, this study contributes to the literature on the adoption of LA in HEIs by integrating trust factors., Competing Interests: Conflict of interestWe have no conflicts of interest to disclose., (© The Author(s) 2023.)

Diabetes mellitus (DM) is a major health issue in Saudi Arabia. Prevention of DM and its complications requires an understanding of the disease and modifiable behaviors (e.g., physical activity-PA). The purpose of this study was to examine the trends in knowledge of the general population regarding DM to better understand the shortcomings in the current awareness programs. This article presents a cross-sectional series study where a survey was distributed to a total of 3493 participants over four years, from 2017 till 2020, to assess general knowledge about DM, including information about PA. The mean percentage of correct responses of DM general knowledge was 63.8 ± 19.0 in 2017, which decreased to 61.3 ± 18.7 in 2020 with a significant beta coefficient of -0.8 ± 0.2 ( p < 0.001). Participants' awareness about PA remained constantly high for four years: the mean percentage of correct responses was 82.1 ± 23.6 in 2017 and 82.0 ± 23.1 in 2020, and the beta coefficient was -0.5 ± 0.3 ( p = 0.147). Furthermore, stratification by demographics showed that the majority of the subgroups (age, sex, educational status, marital status, having relative with DM, nationality) reported a significant declining trend in general DM knowledge. In addition, some of the subgroups also showed a declining trend in PA awareness. Future prevention efforts should assess the community's DM knowledge regularly to tailor awareness efforts to the population segments that need heightened educational interventions.

Potential benefits of learning analytics (LA) for improving students' performance, predicting students' success, and enhancing teaching and learning practice have increasingly been recognized in higher education. However, the adoption of LA in higher education institutions (HEIs) to date remains sporadic and predominantly small in scale due to several socio-technical challenges. To better understand why HEIs struggle to scale LA adoption, it is needed to untangle adoption challenges and their related factors. This paper presents the findings of a study that sought to investigate the associations of adoption factors with challenges HEIs face in the adoption of LA and how these associations are compared among HEIs at different scopes of adoption. The study was based on a series of semi-structured interviews with senior managers in HEIs. The interview data were thematically analysed to identify the main challenges in LA adoption. The connections between challenges and other factors related to LA adoption were analysed using epistemic network analysis (ENA). From senior managers' viewpoints, ethical issues of informed consent and resistance culture had the strongest links with challenges of learning analytic adoption in HEI; this was especially true for those institutions that had not adopted LA or who were in the initial phase of adoption (i.e., preparing for or partially implementing LA). By contrast, among HEIs that had fully adopted LA, the main challenges were found to be associated with centralized leadership, gaps in the analytic capabilities, external stakeholders, and evaluations of technology. Based on the results, we discuss implications for LA strategy that can be useful for institutions at various stages of LA adoption, from early stages of interest to the full adoption phase., Competing Interests: Conflict of interestNone., (© The Author(s) 2022.)

Nutrition-acquired osteomalacia is a bone mineralization disorder associated with dietary calcium and/or solar vitamin D deficiency, risk factors considered common in the Middle Eastern region. Establishing less invasive, cheap, and widely available diagnostic markers for this underdiagnosed entity is essential, in particular for screening in high-risk groups. This study assessed the prevalence of biochemical osteomalacia in Arab adolescents. In this cross-sectional study performed between September 2019 and March 2021, adolescents aged 12−17 years from 60 different secondary and preparatory year schools in Riyadh, Saudi Arabia were included. Anthropometrics and fasting blood samples were collected. Biochemical osteomalacia was defined as any two of the following four serum markers of hypomineralization, namely low 25 hydroxyvitamin D (25OHD < 30 nmol/L), high alkaline phosphatase (ALP), low calcium (Ca), and/or inorganic phosphorous (Pi). A total of 2938 Arab adolescents [1697 girls; mean age (years) 14.8 ± 1.8; 1241 boys; mean age 15.1 ± 1.6] were recruited. Vitamin D deficiency was noted in 56.2% (n = 953) of girls and 27.1% (n = 336) of boys (p < 0.001). The overall prevalence of biochemical osteomalacia was 10.0% (n = 295/2938) and was higher in girls than boys (14.7% vs. 3.6%, p < 0.001). The prevalence of low serum Ca and/or Pi was also higher in girls than in boys (24.2% vs. 12.5%, respectively, p < 0.001), as well as elevated ALP (5.1% vs. 1.5%, p < 0.001). Overall, girls were 4.6 times (95% CI 3.3−6.4) more likely to have biochemical osteomalacia than boys. Screening of apparently healthy Arab adolescents revealed a high prevalence of deranged mineralization markers suggestive of biochemical osteomalacia, which was significantly more common in girls than boys and was likely associated with Arab traditional clothing and diet. The proposed combination of typically altered mineralization markers for the diagnosis of osteomalacia is, at best, suggestive until further comparisons with established diagnostic tools (histological analysis of bone biopsies) are conducted.

Aims/introduction: This study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN), painful DPN and diabetic foot ulceration (DFU) in patients with type 2 diabetes in secondary healthcare in Qatar, Kuwait and the Kingdom of Saudi Arabia., Materials and Methods: Adults aged 18-85 years with type 2 diabetes were randomly enrolled from secondary healthcare, and underwent clinical and metabolic assessment. DPN was evaluated using vibration perception threshold and neuropathic symptoms and painful Diabetic Peripheral Neuropathy was evaluated using the Douleur Neuropathique 4 questionnaire., Results: A total of 3,021 individuals were recruited between June 2017 and May 2019. The prevalence of DPN was 33.3%, of whom 52.2% were at risk of DFU and 53.6% were undiagnosed. The prevalence of painful DPN was 43.3%, of whom 54.3% were undiagnosed. DFU was present in 2.9%. The adjusted odds ratios for DPN and painful DPN were higher with increasing diabetes duration, obesity, poor glycemic control and hyperlipidemia, and lower with greater physical activity. The adjusted odds ratio for DFU was higher with the presence of DPN, severe loss of vibration perception, hypertension and vitamin D deficiency., Conclusions: This is the largest study to date from the Middle East showing a high prevalence of undiagnosed DPN, painful DPN and those at risk of DFU in patients with type 2 diabetes, and identifies their respective risk factors., (© 2022 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.)

Background and objective: There is limited information as to the association of several key bone markers with bone mineral density (BMD) in understudied ethnic groups. This study investigated the relationship between circulating levels of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-Β ligand (RANKL) with BMD in Arab postmenopausal women. Materials and methods: In this cross-sectional study, a total of 617 Saudi postmenopausal women from the Osteoporosis Registry of the Chair for Biomarkers of Chronic Diseases were included. Anthropometric data, BMD, and biochemical data were retrieved from the registry. Participants were stratified into three groups based on T-score; n = 169 with osteoporosis, n = 282 with osteopenia, and n = 166 normal. Analysis of bone markers including RANKL, OPG, osteocalcin, and N-terminal telopeptide (NTx) was completed using commercially available bioassays. Results: The results suggested that OPG was significantly and positively correlated with age in the osteoporosis group (r = 0.29, p < 0.05), while it was inversely correlated with BMD femoral neck left (r = −0.56, p < 0.001) and BMD femoral neck right (r = −0.37, p < 0.05) in the same group. Moreover, RANKL showed a significant inverse correlation with NTx in the osteopenia group (r = −0.37, p < 0.05). Furthermore, the RANKL/OPG ratio had a positive and significant correlation with BMI (r = 0.34, p < 0.05), BMD femoral neck left (r = 0.36, p < 0.05) and BMD femoral neck right (r = 0.35, p < 0.05) in the osteopenia group. By contrast, it showed a significant inverse correlation with waist to hip ratio in the osteoporosis group (r = −0.38, p < 0.05). Multiple regression analysis showed that OPG contributes to BMD variations in the osteopenia group (p = 0.03). Conclusions: In conclusion, changes in circulating levels of RANKL and OPG might be a protective mechanism contrary to the increased bone loss in postmenopausal women.

Objective: Widespread vitamin D deficiency (serum 25-hydroxyvitamin D < 50 nmol/L) in Saudi Arabia (SA) has been documented, yet a time trend is needed to establish where the prevalence is headed. This study aims to fill this gap., Study Design and Setting: This cross-sectional series (N = 7360) were conducted in the central region of SA from 2008 to 2017. Participants of all ages were taken from multiple cohorts that included the Biomarker Screening in Riyadh (2008-2010; N = 1460), the Osteoporosis Registry (2014-2017; N = 1225), Gestational Diabetes Mellitus cohort (2014-2017, N = 281), Vitamin D School Project (2011-2017; N = 3039) and Prediabetes cohort (2012-2017; N = 1355) master databases., Results: Vitamin D deficiency in SA has a 10-year prevalence of 73.2 %. Between 2008-2017, the prevalence of vitamin D deficiency decreased from 87.1% to 64.7% for participants aged 18-40 years (p-trend<0.001), and from 86.2% to 45.7% in participants aged > 40 years (p-trend<0.001). During this period, vitamin D deficiency in females decreased from 80.1% to 69.6% (p-trend<0.001), whereas in males, it decreased from 93.2% to 49.3% (p-trend<0.001). Serum 25(OH)D was observed to have an overall increase of 2.2 ± 0.1 nmol/l (p < 0.001) along with the seasonally adjusted annual increase of 1.3 ± 0.2 nmol/l from 2008 to 2017 (p < 0.001)., Conclusion: The decreasing trend in vitamin D deficiency in SA across all demographics suggests successful public health campaigns over time. It will be interesting to investigate further whether the general improvement in the vitamin D status at the community level also translated in lesser incidences of vitamin d-related diseases over time., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Saudi Arabia is the largest of the Arabian Gulf countries with a total population of 33.41 million as of 2017. This report summarizes the experience from four leading tertiary care hematopoietic stem cell transplantation (HSCT) centers in Saudi Arabia representing more than 90% of all HSCTs performed in the country. Between 1984 and 2016, a total of 6,184 HSCTs were performed. Of these, 3,586 HSCTs were performed in adults and 2,598 HSCTs were performed in pediatric patients. Malignancy was the main indication for transplantation (47%). While most transplants were performed from an identical sibling donor, HSCTs from cord blood, unrelated and, more recently, haploidentical donors have also been performed. Relative shortage of HSCT bed capacity is perceived to be a limiting factor in Saudi Arabia. Lately, more HSCT centers are emerging with rapid growth, which may significantly improve the access to HSCT in the country in the near future., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 King Faisal Specialist Hospital & Research Centre. Published by Elsevier Ltd. All rights reserved.)

We are currently facing an obesity pandemic, with worldwide obesity rates having tripled since 1975. Obesity is one of the main risk factors for the development of non-communicable diseases, which are now the leading cause of death worldwide. This calls for urgent action towards understanding the underlying mechanisms behind the development of obesity as well as developing more effective treatments and interventions. Appetite is carefully regulated in humans via the interaction between the central nervous system and peripheral hormones. This involves a delicate balance in external stimuli, circulating satiating and appetite stimulating hormones, and correct functioning of neuronal signals. Any changes in this equilibrium can lead to an imbalance in energy intake versus expenditure, which often leads to overeating, and potentially weight gain resulting in overweight or obesity. Several lines of research have shown imbalances in gut hormones are found in those who are overweight or obese, which may be contributing to their condition. Therefore, this review examines the evidence for targeting gut hormones in the treatment of obesity by discussing how their dysregulation influences food intake, the potential possibility of altering the circulating levels of these hormones for treating obesity, as well as the role of short chain fatty acids and protein as novel treatments.

Receptor activator of the nuclear factor-κB ligand (RANKL) and osteoprotegerin genes (OPG) were identified as susceptible loci for postmenopausal osteoporosis (PMO) in various ethnicities, but neither have been studied in an Arabian population. Hence, the current study aimed to fill this gap. A total of 372 postmenopausal women (174 osteoporosis (OP) and 198 control group (CTRs)) were genotyped for four SNPs: rs2277438A/G and rs9533156T/C ( RANKL ), and rs2073618C/G and rs3102735T/C ( OPG ). Anthropometrics, bone mineral density, 25(OH)D and several other bone markers were measured. The frequency distribution of the heterozygous CG genotype of rs2073618 ( OPG ) was lower in the OP (36.8%) than in CTRs (47%) (OR: 0.6, 95% CI: 0.3-0.97; p = 0.041). No differences in the allelic/genotypic frequencies were detected between the two groups for all other studied SNPs. However, the heterozygous TC genotype of rs3102735 ( OPG ) was associated significantly with lower BMD at the femoral neck in OP subjects ( p = 0.04). The homozygous rare CC genotype of rs9533156 ( RANKL ) was associated with lower 25(OH)D levels in CTRs ( p = 0.032). In contrast, heterozygous AG genotype of rs2277438 ( RANKL ) is associated with lower 25(OH)D in the OP group ( p = 0.02). Our results suggest that RANKL SNPs may impact 25(OH)D levels and that OPG SNP rs2073618A/G is a significant genetic risk factor for PMO Saudi Arabian women.

The RANKL/RANK/OPG pathway regulates bone remodelling and turnover. However, the genetic background of bone mineral density (BMD) and osteopenia in Saudi postmenopausal women is yet to be studied. We studied the genetic polymorphism of RANKL/RANK/OPG with BMD and other associated factors in Saudi postmenopausal osteopenic women. A total of 439 (223 osteopenia and 216 control) postmenopausal women were recruited from the orthopaedic department of the King Khalid University Hospital, Riyadh, KSA. Genetic variants of RANK (rs1805034 and rs35211496), RANKL (rs2277438 and rs9533156), and OPG (rs2073618 and rs3102735) were genotyped using RT-PCR. Anthropometrics, bone mineral density, and other bone markers were measured. The levels of bone turnover markers, PTH, and RANKL were found to be significantly different between control and the osteopenia group. The odds ratio of 2.37 (1.00-5.69) for RANK SNP (rs1805034) indicates that subjects with CC genotype are more vulnerable to developing osteopenia as compared to subjects with TT genotype. Similarly, for RANKL SNP (rs2277438), the significant odds ratio of 20.56 (9.82-43.06) indicates that the subjects with GG genotype are at significantly higher risk of having osteopenia compared with the AA genotype subjects. In addition, G allele in rs2277438 also found to be a risk factor for osteopenia 4.54 (3.18-6.49) compared with A allele. However, none of the OPG genotypes shows association with osteopenia. The association of RANK polymorphisms with osteopenia shows its clinical importance in the diagnosis and prognosis of the bone diseases; here, we suggest that the subjects with RANK and RANKL polymorphisms may develop osteoporosis., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Saba Abdi et al.)

Background: Management of giant prolactinomas presents a different challenge than the management of traditional prolactinomas., Objective: The aim of this study was to report the largest long-term single-center study of giant prolactinomas to analyze their clinical features; define epidemiological characteristics, comorbidities, complications, treatment outcomes; and to demonstrate our experience with long-term cabergoline (CAB) treatment of these giant tumors., Methods: A retrospective case study and clinical review of patients presenting with giant prolactinomas in the pituitary clinic at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, in the period between 2006 and 2018 were included in the study. Of the charts reviewed, 33 patients (24 men; 9 women) with age of diagnosis between 18 and 63 years (mean = 37.21 years) met the selection criteria for giant prolactinomas., Result: The most common presenting features include headache (87.8%), visual defects (69.7%), and hypogonadism (51.5%). The baseline means serum prolactin (PRL) level was extremely high for both sexes (95 615.03 nmol/L), which eventually decreased by as much as 95.4% after CAB treatment. Serum PRL concentrations completely normalized in 11 patients and significantly reduced in 22 patients. The mean tumor volume at baseline was 42.87 cm 3 , whereas the mean posttreatment tumor volume was 3.42 cm 3 (no residual tumor in 2 patients, while in others, it ranged from 0.11 to 16.7 cm 3 ) at the last follow-up visit. The mean change in tumor volume was 88.84%. Tumor volume decreased by an average of 92% for men and 80.4% for women. One patient had no tumor size change with CAB (3.5 mg thrice a week) or radiotherapy and required surgery. The response rate (remission after medical therapy alone) in this series was 84.84%., Conclusions: Findings reinforce results from our previous study that CAB provides dramatic clinical improvements with an excellent safety profile. The CAB should, therefore, be considered as the primary therapy for giant prolactinomas., Competing Interests: Declaration of Conflicting Interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Aim: This 18 month intervention study aims to determine the efficacy of a lifestyle modification program on prediabetes reversal among Saudi adults., Methods: An 18 month randomized, multicenter trial was conducted among Saudis with prediabetes aged 25-60 recruited from King Salman Hospital and primary care centers in Riyadh, Saudi Arabia. A total of 180 consenting individuals were randomized (1:1) to receive either intensive lifestyle intervention (ILIG) or guidance (control group, CG). ILIG was provided with a personalized lifestyle counseling by nutritionists every 3 months to improve diet and exercise behaviors. CG was given booklets containing information on prediabetes and its prevention. Data from lifestyle assessments and laboratory measurements were analyzed at baseline and every 6 months. The primary outcome was the reversal rate of prediabetes., Results: 158 participants were analyzed (CG:85, ILIG:73) at the 12 month follow-up and 28 participants (CG:11 and ILIG:17) completed the entire 18 month study. Post-intervention, the cumulative incidence of prediabetes reversal in the ILIG was 38 participants (52.1%) which was significantly higher than CG with 26 participants (30.6%) ( p = 0.02)., Conclusion: A tailored lifestyle intervention is effective in reversing prediabetes, at least for a year, among Arab adults with prediabetes. The challenge of sustaining interest in adopting lifestyle changes for a longer duration should be addressed in this population.

Objective: A summary of recommendations is given within the Gulf Cooperation Council (GCC) setting on the assessment and management of vitamin D deficiency in the region., Methods: An assembly of 11 regional experts gathered to formulate an all-inclusive approach to vitamin D deficiency within GCC., Results and Conclusion: Several gaps were identified before regional guidelines could be developed. These include adequacy and standardization of vitamin D testing, frequency of repeated testing and reference ranges, distinguishing prevention from the treatment of vitamin D deficiency, quality assurance of vitamin D products sold within GCC including contents and origins of products, and cut-points for vitamin D levels in local populations. A platform is created that can be further developed for overall regional implementation.

Data on multisystem inflammatory syndrome in children (MIS-C) related to coronavirus disease-19 (COVID-19) is increasing in the current COVID-19 pandemic. We present a 16 year old male who was hospitalized in July 2020 under adult medical service due to Kawasaki-like disease symptoms. Diagnosis of MIS-C related to COVID-19 was established by clinical features, elevated inflammatory markers, and positive SARS-COV 2 immunoglobulin G. We encourage all clinicians especially who practice adult medicine to be familiar with signs and symptoms of MIS-C to avoid delayed diagnosis and complications., Competing Interests: The authors report no declarations of interest., (© 2020 The Author(s).)