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Ashraf Albrakati,1 Khalaf F Alsharif,2 Naif E Al omairi,3 Walaa F Alsanie,2 Abdulraheem SA Almalki,4 Zakaria Y Abd Elmageed,5 Gehad E Elshopakey,6 Maha S Lokman,7,8 Amira A Bauomy,9 Ahmed E Abdel Moneim,8 Rami B Kassab8,10 1Department of Human Anatomy, College of Medicine, Taif University, Taif, Saudi Arabia; 2Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia; 3Department of Internal Medicine, College of Medicine, Taif University, Taif, Saudi Arabia; 4Department of Chemistry, Faculty of Science, Taif University, Taif, Saudi Arabia; 5Department of Pharmacology, Edward via College of Osteopathic Medicine, University of Louisiana at Monroe, Monroe, LA, USA; 6Department of Clinical Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt; 7Biology Department, College of Science and Humanities, Prince Sattam bin Abdul Aziz University, Alkharj, Saudi Arabia; 8Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt; 9Department of Science Laboratories, College of Science and Arts, Qassim University, ArRassAl-Qassim, Saudi Arabia; 10Biology Department, Faculty of Science and Arts, Al Baha University, Al Makhwah Branch, Al Baha, Saudi ArabiaCorrespondence: Ahmed E Abdel MoneimDepartment of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, EgyptTel +20 1153322079Email aest1977@hotmail.comPurpose: Depression is a mood disorder accompanied by intensive molecular and neurochemical alterations. Currently, available antidepressant therapies are not fully effective and are often accompanied by several adverse impacts. Accordingly, the ultimate goal of this investigation was to clarify the possible antidepressant effects of prodigiosins (PDGs) loaded with selenium nanoparticles (PDGs-SeNPs) in chronic unpredictable mild stress (CUMS)-induced depression-like behavior in rats.Methods: Sixty Sprague Dawley rats were randomly allocated into six groups: control, CUMS group (depression model), fluoxetine (Flu, 10 mg/kg)+CUMS, PDGs+CUMS (300 mg/kg), sodium selenite (Na2SeO3, 400 mg/kg)+CUMS, and PDGs-SeNPs+CUMS (200 mg/kg). All treatments were applied orally for 28 consecutive days.Results: PDGs-SeNPs administration prevented oxidative insults in hippocampal tissue, as demonstrated by decreased oxidant levels (nitric oxide and malondialdehyde) and elevated innate antioxidants (glutathione, glutathione peroxidase, glutathione reductase, superoxide dismutase, and catalase), in addition to the upregulated expression of nuclear factor erythroid 2-related factor 2 and heme oxygenase-1 in rats exposed to CUMS. Additionally, PDGs-SeNPs administration suppressed neuroinflammation in hippocampal tissue, as determined by the decreased production of pro-inflammatory cytokines (tumor necrosis factor-alpha, interleukin-1β, and interleukin-6), increased anti-inflammatory cytokine interleukin-10, and decreased inflammatory mediators (prostaglandin E2, cyclooxygenase-2, and nuclear factor kappa B). Moreover, PDGs-SeNPs administration in stressed rats inhibited neuronal loss and the development of hippocampal apoptosis through enhanced levels of B cell lymphoma 2 and decreased levels of caspase 3 and Bcl-2-associated X protein. Interestingly, PDGs-SeNPs administration improved hormonal levels typically disrupted by CUMS exposure and significantly modulated hippocampal levels of monoamines, brain-derived neurotrophic factor, monoamine oxidase, and acetylcholinesterase activities, in addition to upregulating the immunoreactivity of glial fibrillary acidic protein in CUMS model rats.Conclusion: PDGs-SeNPs may serve as a prospective antidepressant candidate due to their potent antioxidant, anti-inflammatory, and neuroprotective potential.Keywords: chronic unpredictable mild stress, prodigiosin-loaded selenium nanoparticles, oxidative stress, neuroinflammation, apoptosis, neurochemical markers

Ali AS, Almalki AS, Alharthy BT. J Exp Pharmacol. 2020;12:397–407. The authors have advised that the Acknowledgments statement on page 405 is incorrect. The text “The authors acknowledge the Deanship of Scientific Research, King Abdulaziz University, Saudi Arabia, for funding this project (Grant number 20476/1439 H). We gratefully acknowledge Dr. Huda Mohammed Alkreathy for her significant assistance throughout our study and manuscript writing” should read “This project was funded by the Deanship of Scientific Research (DSR) at King Abdulaziz University, Jeddah, under Grant No. G-200-140-1440. The authors, therefore, acknowledge with thanks DSR for technical and financial support. We gratefully acknowledge prof. Huda Mohammed Alkreathy for her significant assistance throughout our study and manuscript writing”. The authors apologize for this error.

The study aimed to reveal the degree of special education teachers' employment of electronic educational games in teaching the disabled. It also showed statistical differences according to the variables of gender, academic qualification, and years of experience. To achieve the objectives of the study, the descriptive survey method was used. The study sample consisted of (96) male and female teachers, of whom (47) male and (47) female teachers were chosen in a stratified random manner from the Directorate of Education for Najran region in the Kingdom of Saudi Arabia in the academic year 2022/2023. A questionnaire consisting of (30) items was used, distributed in three domains: planning, implementation, and evaluation. The results showed that the degree of special education teachers' employment of electronic educational games in teaching students with disabilities obtained a mean of (2.57), with a low degree. The results also showed that there are statistically significant differences in the responses of the study sample about the degree of special education teachers' employment of electronic educational games in teaching students with disabilities due to the variables of academic qualification in favor of postgraduate studies, and years of experience in favor of more than ten years. However, there was no statistically significant difference due to the gender variable. The study recommended that the Ministry of Education should pay attention to holding and organizing various specialized training programs to develop the capabilities of special education teachers to employ electronic educational games in teaching, especially in planning, implementation, and evaluation.

Ahmed Shaker Ali,1,2 Abdullah Saddah Almalki,1,3 Basma Tarek Alharthy1 1Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt; 3Department of Pharmacy, Ajyad Hospital, Ministry of Health, Riyadh, Saudi ArabiaCorrespondence: Abdullah Saddah Almalki Makkah 24268 – 9382, Kingdom of Saudi ArabiaTel +966 126401000 - Ext 20151Fax +966 126400855Email a1410s@hotmail.comBackground: The kidneys are considered one of the most susceptible organs for adverse drug effects, particularly in post-transplant conditions. Tacrolimus (FK506), a calcineurin inhibitor immunosuppressant, is an essential component in the transplantation regimen. Despite that, nephrotoxicity is a severe drawback for its chronic utilization, where oxidative stress might be implicated. Kaempferol (KMF) is a natural flavonoid that has many adaptable biological activities, including antioxidant action.Objective: Exploring the KMF protective effect on FK506-induced nephrotoxicity and the underlying role of calcineurin B1.Methods: Twenty-four male albino-Wistar rats were randomly divided into three equal groups. The control group received solvents: propylene glycol, i.p. and 0.5% carboxymethyl cellulose, PO; FK506 group was injected with FK506 (0.6 mg/kg, i.p.), and FK506+KMF group was given FK506 (0.6 mg/kg, i.p.) and KMF (10 mg/kg, PO). The treatment regimen for all groups was once daily for 30 days. ELISA technique applied for measuring FK506 trough level and nephrotoxicity biomarkers in serum (cystatin C and urea) on days 15 and 30, and in kidney tissue homogenate (MDA and calcineurin B1) on day 30.Results: In FK506-treated rats, the FK506 trough level was 7.84 ± 1.31 ug/l on day 15 and 9.54 ± 1.45 ug/l on day 30. FK506 use has significantly (P< 0.01) increased biomarkers levels of cystatin C (325% and 477%), urea (177% and 245%), MDA (1253%), except calcineurin B1 that has decreased (97%). The KMF combination has resulted in a significant reduction in the FK506 trough level by day 30 (6.79 ± 1.35 ug/l, P< 0.01). KMF has significantly ameliorated the levels of cystatin C (46% and 73%, P< 0.001), urea (38% and 68%, P< 0.001), MDA (75%, P< 0.001), and calcineurin B1 (1833%, P< 0.05).Conclusion: Oxidative stress and calcineurin B1 are contributing factors in FK506-induced nephrotoxicity. Hence, inhibition of calcineurin enzyme is not limited to the immune cells. KMF could be a novel nephroprotective antioxidant.Keywords: FK506, kaempferol, calcineurin B1, nephrotoxicity, biomarkers

Anas Awad Alsolami,1 Khalid Z Alshali,1 Marwan Ahmad Albeshri,1 Shikih Hussain Alhassan,1 Abdalrhman Mohammed Qazli,1 Ahmed Saad Almalki,1 Marwan A Bakarman,2 Abdel Moniem Mukhtar1 1Faculty of Medicine, Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia Objectives: Type 2 diabetes mellitus (DM-II) is highly prevalent in Saudi Arabia and only few studies have assessed it as a risk factor for hypothyroidism. This study aimed to examine the association between DM-II and hypothyroidism. Subjects and methods: We conducted a hospital-based case–control study. As cases, we included all adults admitted to King Abdulaziz University Hospital (KAUH) with laboratory-confirmed hypothyroidism. As controls, we drew a random sample of patients admitted to the orthopedic clinic at KAUH with laboratory-confirmed absence of hypothyroidism. We extracted data from the medical records regarding age, sex, presence of DM-II, HbA1c, comorbidities, treatment, and complications. We used multivariate logistic regression to identify factors associated with hypothyroidism. Results: We included 121 cases and 121 controls. In comparison to controls, cases were older (P=0.005), had higher prevalence of DM-II (P

The study aimed to reveal the degree of using blended learning among teachers of students with learning disabilities in the Kingdom of Saudi Arabia. It also showed statistical differences according to the variables of gender, academic qualification, and years of experience. To achieve the objectives of the study, the descriptive survey design was used. The sample of the study consisted of (110) male and female teachers of students with learning disabilities, of whom (53) male and (57) female teachers were chosen by the stratified random method from the educational regions in the south of the Kingdom of Saudi Arabia in the second semester of the academic year 2022/2023. A questionnaire consisting of (22) items was used, distributed in three domains: planning, implementation, and evaluation, after verifying the indications of its validity and reliability. The results showed that the degree of using blended learning among teachers of students with learning disabilities in all domains and the total score was moderate. The results also showed that there are statistically significant differences in the answers of the study sample about the degree of using blended education among teachers of students with learning disabilities due to the variables of academic qualification in favor of postgraduate studies and years of experience in favor of more than ten years. However, there was no statistically significant difference due to the gender variable. The study recommended that the Ministry of Education in the Kingdom of Saudi Arabia should provide training requirements for teachers with learning disabilities on blended education and include them in their teaching practices (planning, implementation, and evaluation).

This study contributes to the Global Southern epistemological debates on the professional identity negotiations of Global-North-educated English as a Foreign Language (EFL) instructors. Using semi-structured interviews, the study analyses how two Saudi Arabian EFL instructors, during their PhD studies in the United States, and upon their return home, coped with the phenomenon of native-speakerism and navigated their way through the binary of Native English-Speaking Teachers (NEST) and Non-Native English-Speaking Teachers (NNEST) in their teaching. They appreciated their Western education not due to the traditional privileged-Global-North-and-underprivileged-Global-South binary but because of the many ways in which it helped them negotiate their translingual identity. They saw themselves as better placed to give constructive feedback to learners but critiqued the NESTs' inability to base themselves in the local culture and positioned themselves above NESTs due to their knowledge of indigenous Saudi culture. Thus, they dismantled the traditional privilege associated with native-speakerism but did not hail one category over the other. Instead, they picked from both categories the materials, ways, means and attitudes that best served their purpose. They strove for hybridity. Through their negotiation of their foreign education and local challenges, they developed a unique translingual identity.

Abstract In the race to combat ever-evolving diseases, the drug discovery process often faces the hurdles of high-cost and time-consuming procedures. To tackle these challenges and enhance the efficiency of identifying new therapeutic agents, we introduce VirtuDockDL, which is a streamlined Python-based web platform utilizing deep learning for drug discovery. This pipeline employs a Graph Neural Network to analyze and predict the effectiveness of various compounds as potential drug candidates. During the validation phase, VirtuDockDL was instrumental in identifying non-covalent inhibitors against the VP35 protein of the Marburg virus, a critical target given the virus’s high fatality rate and limited treatment options. Further, in benchmarking, VirtuDockDL achieved 99% accuracy, an F1 score of 0.992, and an AUC of 0.99 on the HER2 dataset, surpassing DeepChem (89% accuracy) and AutoDock Vina (82% accuracy). Compared to RosettaVS, MzDOCK, and PyRMD, VirtuDockDL outperformed them by combining both ligand- and structure-based screening with deep learning. While RosettaVS excels in accurate docking but lacks high-throughput screening, and PyRMD focuses on ligand-based methods without AI integration, VirtuDockDL offers superior predictive accuracy and full automation for large-scale datasets, making it ideal for comprehensive drug discovery workflows. These results underscore the tool’s capability to identify high-affinity inhibitors accurately across various targets, including the HER2 protein for cancer therapy, TEM-1 beta-lactamase for bacterial infections, and the CYP51 enzyme for fungal infections like Candidiasis. To sum up, VirtuDockDL combines user-friendly interface design with powerful computational capabilities to facilitate rapid, cost-effective drug discovery and development. The integration of AI in drug discovery could potentially transform the landscape of pharmaceutical research, providing faster responses to global health challenges. The VirtuDockDL is available at https://github.com/FatimaNoor74/VirtuDockDL .

Abstract Background This study aimed to investigate the in vitro effect of a charcoal-containing dentifrice with different toothbrush stiffness on enamel. Methods Four main groups were applied: distilled water, conventional fluoridated toothpaste (Colgate® Total® 12 Clean Mint Toothpaste), charcoal toothpaste (Colgate® Total® Charcoal Toothpaste) and whitening toothpaste (Colgate Total® Advanced Whitening Toothpaste). Three subgroups for each toothpaste were further included according to the toothbrush bristles’ stiffness (soft, medium, and hard). Enamel specimens were subjected to 1,250 and 2,500 cycles of brushing using toothbrushing simulation machine. The average surface roughness change (ΔRa) in nanometer (nm) was measured to estimate the changes following the brushing simulation model. Two-way ANOVA and Tukey tests analyzed the data. Results The type of toothpaste and the bristles’ stiffness were determinant factors in increasing the ΔRa value (P =

Abstract Chitosan nanoparticles (NPs) are well-recognized as promising vehicles for delivering anticancer drugs due to their distinctive characteristics. They have the potential to enclose hydrophobic anticancer molecules, thereby enhancing their solubilities, permeabilities, and bioavailabilities; without the use of surfactant, i.e., through surfactant-free solubilization. This allows for higher drug concentrations at the tumor sites, prevents excessive toxicity imparted by surfactants, and could circumvent drug resistance. Moreover, biomedical engineers and formulation scientists can also fabricate chitosan NPs to slowly release anticancer agents. This keeps the drugs at the tumor site longer, makes therapy more effective, and lowers the frequency of dosing. Notably, some types of cancer cells (fallopian tube, epithelial tumors of the ovary, and primary peritoneum; lung, kidney, ependymal brain, uterus, breast, colon, and malignant pleural mesothelioma) have overexpression of folate receptors (FRs) on their outer surface, which lets folate-drug conjugate–incorporated NPs to target and kill them more effectively. Strikingly, there is evidence suggesting that the excessively produced FR&αgr (isoforms of the FR) stays consistent throughout treatment in ovarian and endometrial cancer, indicating resistance to conventional treatment; and in this regard, folate-anchored chitosan NPs can overcome it and improve the therapeutic outcomes. Interestingly, overly expressed FRs are present only in certain tumor types, which makes them a promising biomarker for predicting the effectiveness of FR-targeted therapy. On the other hand, the folate-modified chitosan NPs can also enhance the oral absorption of medicines, especially anticancer drugs, and pave the way for effective and long-term low-dose oral metronomic scheduling of poorly soluble and permeable drugs. In this review, we talked briefly about the techniques used to create, characterize, and tailor chitosan-based NPs; and delved deeper into the potential applications of folate-engineered chitosan NPs in treating various cancer types. Graphical Abstract Schematic illustration of target ligand-drug incorporated chitosan nanoparticles and its advantage in treating cancer. Figure created with BioRender.Com.

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

Abdulmajeed Alshowair,1 Abdullah M Assiri,2 Abdullah Hussein Balfas,3 Rakan Alkhattabi,3 Tilal Abdalla Eltegani,3 Sara Altowairib,3 Abdullah Hamed Almalki,3 Eman Ahmed Alharbi,3 Suad Alotai,3 Fahad Alobaid,3 Najeeb Saud S Altowiher3 1Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 2Preventive Health, Ministry of Health, Riyadh, Saudi Arabia; 3Public Health Directorate, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi ArabiaCorrespondence: Abdulmajeed Alshowair, Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia, Tel +966547135224, Email dr.a.majeed@gmail.comPurpose: To estimate the prevalence and determinants of latent tuberculosis (LTBI) among inmates of four correctional facilities in Saudi Arabia.Methods: This is a retrospective review of health records. All inmates of four correctional facilities in Saudi Arabia were screened for tuberculosis in 2022. Their LTBI status was defined as more than 10mm Mantoux test result and negative X-ray chest result. The prevalence of LTBI and their determinants like age, gender, country of origin, location of the prison, and human immunodeficiency viruses (HIV) status were studied.Results: We reviewed screening data of 10,042 inmates in four Saudi prisons. The prevalence of LTBI was 7.4%. The risk difference of LTBI was significantly higher in males compared to female inmates (P < 0.001). The highest prevalence of LTBI was noticed among males (7.7%), those older than 60 years old (26.9%), and African expatriates (12.1%). None of the female inmates or those with HIV had LTBI. The binomial regression analysis revealed a highly significant effect of older age on the risk of having LTBI.Conclusion: The prevalence of LTBI was low among inmates at Saudi correctional facilities. The males, old age, and persons from African and Asian countries had a higher risk of LTBI. The prevalence of LTBI among inmates of Saudi prisons could be predicted by knowing their age group.Keywords: tuberculosis, latent tuberculosis, inmate screening

In this paper, we explore the dynamics of the global quantum discord (GQD) and quantum Fisher information (QFI) of a multipartite two-level stationary and moving atomic system under the Stark shift effect. The system interacts with a thermal field with a different number of average thermal photons. For a fixed Stark parameter value, the GQD magnitudes increase as the system size (N) increases for both static and moving atomic systems. However, in the instance of a stationary atomic system and lower Stark parameter values, the QFI preserves a constant magnitude for different N values. When atomic motion is taken, the quantifier dynamics exhibit periodic oscillations. Additionally, increasing the Stark parameter led to a suppression in the magnitude of both GQD and QFI. With in the sight of intrinsic decoherence (ID), the quantifiers show a damping in their oscillations. Interestingly, the atomic motion assists to mitigate the damping effects caused by ID. Moreover, if the average thermal photons are increased, the magnitude of the GQD and QFI are decreased.

Throughout history, humans have heavily relied on plants for both nourishment and the treatment of diseases. Breast cancer chemotherapies are expensive, have side effects, and may develop resistant cells. This shows the need for natural therapies to reduce the side effects of pharmacological remedies. Our objective was to isolate phytochemicals from the ethanol extract of the Eugenia uniflora plant. Another objective was to assess the antioxidant activity of the crude ethanolic extract of E. uniflora leaves and predict the drug-likeness, pharmacokinetics, and binding potentials of the identified phytochemicals as anti-breast cancer agents. From the results, fifteen phytochemicals were isolated and identified. The average total phenolic content (TPC), total flavonoid content (TFC), radical scavenging activity (DPPH), and ferric reducing antioxidant power (FRAP) values for the ethanol extract were 119.5 mg GAE/g, 141.16 mg GAE/g, 37.8 µg/mL, and 7.2 mmol/g, respectively. The chemical composition revealed 15 compounds: 3-Undecene, Acetic acid, Benzofuran, Hydroquinone, alpha-L-Galactopyranose, Methyl hexofuranoside, Nonadecanoic acid, 10-Octadecenoic acid, 2-Nonen-1-ol, Z-8-Methyl-9-tetradecenoic, 10-Undecenal, 2-Octylcyclopropene-1-heptanol, 1,5-Cyclododecadiene, Allantoic acid, and Stearic acid hydrazide. The drug-likeness and ADME properties of the fifteen identified compounds revealed non-violation of Lipinski's rules of five requirements. The docking screening of the fifteen identified phytochemicals with the human placental aromatase target revealed Stearic acid hydrazide, with the highest binding affinity of −7.86 kcal/mol, which can serve as a competitive aromatase inhibitor. The in-silico study gave a high probability that some of these compounds could be used as aromatase inhibitors and thus play a role in treating breast cancer. As far as we are aware, there has been no prior research conducted on the potential inhibitory effects of certain compounds found in E. uniflora on the aromatase enzyme.

Background: Illness uncertainty was found to be associated with the development of depressive and anxiety symptoms among patients with type 1 diabetes and chronic illness in general. However, the moderating effect of illness uncertainty was not examined in sufficient depth. The current study evaluates how the path from diabetes distress to depression and anxiety is mediated by illness uncertainty, ambiguity, symptoms and course predictability, and illness complexity. Method: Descriptive cross-sectional survey of a large-scale sample of patients living with type one diabetes in Saudi Arabia. We utilized structural equation modelling mediation analysis to examine the effect of illness uncertainty and its subcategories (illness-related ambiguity, symptoms and course predictability, and illness complexity) on depressive and anxiety symptoms. Results: The current survey analyzed data pertaining to (n = 536) type one diabetes patients. Mean Mishel Uncertainty of Illness Scale score was 80.8 points (Cronbach’s α = 0.91) signifying moderate uncertainty among our patients. Diabetes-related uncertainty was associated with marriage (t = 3.337, P = 0.0009937), diabetes complications (t = 5.257, P < 0.00001), pain (r = 0.2247, P < 0.00001), and children count (correlation coefficient r = 0.195, P < 0.00001). The prevalence of depression was (n = 367, 68.5%) and for anxiety was (n = 173, 30.3%). Illness uncertainty correlated with depressive (r = 0.2484, P < 0.00001) and anxiety (r = 0.2548, P < 0.00001) symptoms’ scores. Illness uncertainty exerted a partial moderating effect on both anxiety (β = 0.060, P < 0.001) and depressive symptoms (β =0.056, P < 0.001). We observed a partial moderating effect for diabetes-related ambiguity and diabetes-related symptom unpredictability in terms of depressive and anxiety symptoms. However, for diabetes-related course unpredictability, the moderating effect was significant only for anxiety. Diabetes-related complexity did not exert a significant moderating effect on either depressive or anxiety symptoms. Discussion: We confirmed high levels of depression and anxiety among patients with type one diabetes in Saudi Arabia. Our findings suggest that illness uncertainty affects both diabetes-related distress and depression constructs and is likely to be affected by them.

Sultan Abdulrahman Almalki,1,&ast; Inderjit Murugendrappa Gowdar,1,&ast; Faisal Omar Arishi,2 Rakan Khaled Alhumaidani,2 Faisal Khaled Alhumaidani,2 Khalid Gufran1 1Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; 2College of Dentistry, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Khalid Gufran, Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia, Tel +00966502294308, Email k.syed@psau.edu.saBackground: Whether there is a relationship between blood group and the likelihood of acquiring oral diseases. Therefore, the present study investigated the potential association between ABO blood groups and various dental conditions, including dental caries, gingivitis, malocclusion, and impacted teeth, in Saudi adults aged 18 years and older.Methods: A cross-sectional study was conducted on 300 participants who met the inclusion criteria. Data collection included assessment of dental caries status using the decayed missing filled teeth (DMFT) and decayed missing filled surfaces (DMFS) indices, evaluation of gingivitis using the Gingival Index, classification of malocclusion according to Angle’s classification system, and recording the presence or absence of impacted teeth.Results: The AB blood group had the significantly highest mean DMFS score (8.58± 6.63), while the O blood group had the lowest mean DMFS score (6.37± 4.43). Additionally, blood group O showed a slightly higher prevalence of gingivitis (51.92%) than the other blood groups. Blood group A demonstrated a higher prevalence of both Class II (34.2%) and Class III (19%) malocclusions, with statistically significant differences. Regarding impacted teeth, blood group AB (48.8%) had the highest occurrence.Conclusion: There exists an association between oral disease and ABO blood group in Saudi adults. The results of this study indicate that individuals with specific blood types may be more prone to oral diseases, which can aid in the early diagnosis and prevention of these conditions.Keywords: ABO blood groups, dental caries, gingivitis, malocclusion, impacted teeth

Abstract Background Given the increasing frequency of disasters globally, it is critical that healthcare systems are prepared for these mass casualty events. The Saudi health system’s preparedness for mass casualty incidents needs to be more robust, potentially due to limited disaster drills and inadequate standardized patient (SP) simulation training. This study aims to (i) assess the performance of front-line hospital staff in Saudi Arabia through a functional drill and (ii) evaluate the drill’s effectiveness using SP and MAC-SIM cards, providing detailed insights into its design and execution. Methods A functional drill was conducted at a government hospital in Riyadh, Saudi Arabia, on December 19, 2022, using a cross-sectional approach with two phases. 141 healthcare receivers served as subjects, while 23 volunteers acted as SPs. The scenario simulated a building collapse to assess the emergency department (ED) response, interdepartmental communication, and surge capacity. Data were collected through direct observation of healthcare practitioners’ interactions with the SPs, analysis of SP data, and participant feedback. Quantitative data were analyzed descriptively, while qualitative data were examined for patterns and themes related to simulation performance and effectiveness. Results The hospital receivers’ performances demonstrated accurate triage categories. The ED team assessed most patients (67%) in less than 5 min. For patients requiring definitive care, such as intensive care unit, 95% spent less than 2.5 h in the ED. Most patients (65%) required ‘other treatments’. Communication was efficient in the triage zone and the yellow treatment area. Participants’ feedback on using MAC-SIM cards during the simulation was overwhelmingly positive with 82.61% reporting that MAC-SIM use helped them respond better. Experienced SPs (paramedics) with prior disaster knowledge and experience outperformed inexperienced SPs (nurses) in the functional exercise. Conclusion This groundbreaking study is the first in the Arabic Gulf region to use SPs with MAC-SIM cards in functional drills. The findings highlight the potential of simulation exercises to improve hospital team knowledge and performance when responding to disasters. Multiple evaluation techniques can effectively identify participant strengths and weaknesses, informing future disaster improvement plans. This information is a valuable resource for Arabic and middle-income countries where disaster medicine is still developing.

Abstract Background Segmentation of skin lesions remains essential in histological diagnosis and skin cancer surveillance. Recent advances in deep learning have paved the way for greater improvements in medical imaging. The Hybrid Residual Networks (ResUNet) model, supplemented with Ant Colony Optimization (ACO), represents the synergy of these improvements aimed at improving the efficiency and effectiveness of skin lesion diagnosis. Objective This paper seeks to evaluate the effectiveness of the Hybrid ResUNet model for skin lesion classification and assess its impact on optimizing ACO performance to bridge the gap between computational efficiency and clinical utility. Methods The study used a deep learning design on a complex dataset that included a variety of skin lesions. The method includes training a Hybrid ResUNet model with standard parameters and fine-tuning using ACO for hyperparameter optimization. Performance was evaluated using traditional metrics such as accuracy, dice coefficient, and Jaccard index compared with existing models such as residual network (ResNet) and U-Net. Results The proposed hybrid ResUNet model exhibited excellent classification accuracy, reflected in the noticeable improvement in all evaluated metrics. His ability to describe complex lesions was particularly outstanding, improving diagnostic accuracy. Our experimental results demonstrate that the proposed Hybrid ResUNet model outperforms existing state-of-the-art methods, achieving an accuracy of 95.8%, a Dice coefficient of 93.1%, and a Jaccard index of 87.5. Conclusion The addition of ResUNet to ACO in the proposed Hybrid ResUNet model significantly improves the classification of skin lesions. This integration goes beyond traditional paradigms and demonstrates a viable strategy for deploying AI-powered tools in clinical settings. Future work Future investigations will focus on increasing the version's abilities by using multi-modal imaging information, experimenting with alternative optimization algorithms, and comparing real-world medical applicability. There is also a promising scope for enhancing computational performance and exploring the model's interpretability for more clinical adoption.

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

Amr J Halawani,1 Hisham I Abu-Tawil,2,3 Salah Alharbi,4 Bandar S Almalki,5 Fawaz M Majmi,6 Renad A Miny,1 Nada G Alghoribi,1 Sulaiman S Alabsi,7 Saeed M Kabrah,1 Haneen O Alhaj,8 Musaed M Alshahrani,9 Nora Y Hakami10 1Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 2Department of Laboratory and Blood Bank, Prince Mohammed Bin Nasser Hospital, Ministry of Health, Jazan, Saudi Arabia; 3Department of Laboratory and Blood Bank, King Faisal Medical City for Southern Regions, Ministry of Health, Abha, Saudi Arabia; 4Armed Forces Hospital in Jazan, Ministry of Defence, Jazan, Saudi Arabia; 5General Medical Committee, tDirectorate General of Health Affairs, Jazan, Saudi Arabia; 6Department of Pharmacy, Ahad Al Masarihah General Hospital, Ministry of Health, Jazan, Saudi Arabia; 7King Abdulaziz Medical City, Jeddah, Saudi Arabia; 8Kholoud Laboratory for Medical Analysis, Makkah, Saudi Arabia; 9Blood Bank Laboratory, Prince Sultan Military Medical City, Saudi Arabia; 10Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Amr J Halawani, Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences Umm Al-Qura University, Makkah, Saudi Arabia, Email ajjhalawani@uqu.edu.saPurpose: Jazan Province in Saudi Arabia is notable for its high prevalence of inherited hemoglobinopathies, including sickle cell disease and thalassemia, necessitating frequent blood transfusions for affected individuals. To mitigate risks such as RBC alloimmunization and hemolytic transfusion reactions, ensuring blood compatibility is crucial. The Kell (KEL) blood group system, pivotal alongside the ABO and RH systems, encompasses multiple antigens implicated in these complications. This study aimed to investigate the frequencies of KEL blood group antigens (K, k, Kpa, and Kpb) and determine KEL phenotypes (K/k and Kpa/Kpb) among Saudi blood donors living in Jazan Province.Methods: A total of 138 anonymous healthy Saudi blood donors from Prince Mohammed bin Nasser Hospital in Jazan Province, Saudi Arabia, were enrolled in this study. Anticoagulated blood was analyzed using the gel card technique to assess K, k, Kpa, and Kpb antigens.Results: The prevalence of KEL antigens was as follows: K (n = 9, 6.52%), k (n = 137, 99.28%), Kpa (n = 1, 0.72%), and Kpb (n = 138, 100%). KEL phenotypes observed were K+k+ (n = 8, 5.80%), K+k− (n = 1 0.72%), K−k+ (n = 129, 93.48%), Kp(a+b+) (n = 1, 0.72%), and Kp(a−b+) (n = 137, 99.28%).Conclusion: This study provides insights into the prevalence of KEL blood group antigens and phenotypes in Jazan Province, Saudi Arabia. These findings may contribute to the establishment of a national blood group database and guide transfusion practices to ensure compatibility and minimize alloimmunization risks.Keywords: Kell blood group, blood transfusion, immunohematology, Saudi Arabia