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Abdullah Dalboh,1 Walid M Abd El Maksoud,1 Khaled S Abbas,1 Hassan A Alzahrani,1 Mohammed A Bawahab,1 Fahad S Al Amri,1 Marei H Alshandeer,1 Maha A Alghamdi,1 Meshal S Alahmari,2 Abdulaziz M Alqahtani,2 Mansour S Alqahtani,2 Aljohrah M Alqahtani,2 Leinah H Alshahrani2 1Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia; 2College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Walid M Abd El Maksoud, General Surgery Department, Faculty of Medicine, King Khalid University, P. O. 641, Abha, 61421, Saudi Arabia, Tel +966543128555, Email wabdulmksoud@kku.edu.saBackground: The relationship between laparoscopic sleeve gastrectomy (LSG) and gastroesophageal reflux disease (GERD) is intricate. Hiatal hernia repair or gastropexy can have an impact on postoperative GERD.Aim: To assess the effect of the repair of an accidentally discovered HH and/or gastropexy on the development of de novo postoperative GERD symptoms after LSG.Methods: This retrospective study included all obese patients who underwent LSG at our hospital from January 2018 to June 2022. The data retrieved from patients’ files comprised demographic and clinical data, including BMI, GERD symptoms, and comorbidities. Hiatal hernias, surgical technique, gastropexy, duration, and intraoperative complications were recorded. Postoperative data included early and late postoperative complications, weight loss, de novo GERD, and medication use.Results: The study included 253 patients, 89 males (35.2%) and 164 females (64.8%), with a mean age of 33.3± 10.04 years. De novo GERD was detected in 94 individuals (37.15%). HH was accidentally found and repaired in 29 patients (11.5%). Only 10.3% of LSG and HH repair patients had de novo GERD symptoms, compared to 40.6% of non-HH patients. 149 patients (58.9%) had gastropexy with LSG. Postoperative de novo GERD symptoms were comparable for LSG with gastropexy (40.5%) and LSG alone (40.9%).Conclusion: After one year, concurrent hiatal hernia repair and LSG seem to be safe and beneficial in lowering postoperative de novo GERD symptoms. The inclusion of gastropexy with LSG had no significant impact on postoperative de novo GERD. Both HH repair and gastropexy lengthened the operation but did not increase its complications.Keywords: Obesity, Laparoscopic sleeve gastrectomy, Gastroesophageal reflux disease, GERD, Hiatal hernia, Gastropexy

Microbial diseases remain a leading cause of death worldwide, and the emergence of new infections underscores the need for innovative treatments. Plant-based sources for antimicrobial drugs are gaining popularity due to their fewer side effects compared to synthetic drugs. Corn silk (CS), an ancient medicinal plant, has been used for thousands of years to treat ailments such as edema and cystitis. It is a rich source of vitamins and minerals and acts as an anti-hypertensive, anti-diabetic, anti-cancerous, antioxidant, and antimicrobial agent. Its bioactive components, which include phenolic acids, flavonoids, tannins, alkaloids, terpenes, and saponins, are responsible for these therapeutic benefits. Numerous studies have examined the antibacterial effectiveness of diverse CS extracts, unveiling several methods by which CS demonstrates its antimicrobial properties. These mechanisms include the inhibition of energy production within microbial cells, interference with DNA and protein synthesis, prevention of biofilm formation, disruption of cell wall synthesis, and direct disruption of the cell wall structure. CS effectively blocks microbial growth and multiplication by focusing on these vital processes. Therefore, the purpose of this review is to provide a comprehensive summary of the different bioactive compounds found in CS, as well as their mechanisms of action against microbes. Understanding these mechanisms highlights CS’s potential as a potent source for developing new antimicrobial medications and supplements, offering a natural and effective alternative in the fight against infectious diseases.

Alaa A Alhubaishi,1 Shahad O Alkhaldi,2 Al-Jawhara K Abanumay,2 Sadeem M Alzaidy,2 Abdulhadi M Alqahtani,3 Amal M Badawoud,1 Abdulrahman S Ali,4 Haya F Almoharb,5 Lolwa M Alsharekh,5 Ghadah H Alshehri1 1Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 2PharmD Candidate, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 3Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia; 4National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; 5Department of Pharmacy, Security Forces Hospital, Riyadh, Saudi ArabiaCorrespondence: Ghadah H Alshehri, Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Tel +966118239314, Email ghALShehri@pnu.edu.saBackground: Dementia is a common neurogenerative disease among older adults. Therefore, they are more prone to potentially inappropriate medication (PIM), which is medication that causes more harm rather than protecting the health of an individual. Hence, the American Geriatrics Society (AGS) has recognized the risk of certain medication classes on this population and released PIM according to Beers criteria, which is a helpful guide for clinicians to ensure the safety of medication before it is prescribed. The aim of this study is to assess the prevalence of PIM use among older adults with dementia as a risk factor in comparison to other older adults without dementia.Methods: A retrospective study was conducted in an outpatient setting in a tertiary hospital targeting elderly patients aged 65 years old or over from January 2020 to September 2022. A total of 598 patients were screened, and 270 patients met the inclusion criteria. The eligible patients were then divided into two groups: 168 were in a non-dementia group and 102 were in a dementia group.Results: PIM use was reported in patients with and without dementia. The most inappropriate medication that was prescribed comprised atypical antipsychotics PIM for both patients with and without dementia. However, the prevalence was higher in the dementia group for quetiapine (75% vs 24% respectively), olanzapine (82% vs 17% respectively) or risperidone (92% vs 7%, respectively). Anticholinergics were highly prescribed in older adult without dementia as compared to dementia patient and was statistically significant for solifenacin (96% vs.3.6% respectively) and amitriptyline (88% vs 11% respectively).Conclusion: Among elderly patients in outpatient care settings, the prevalence of PIM use is considered high in dementia patients for antipsychotics, while a higher use of benzodiazepine and anticholinergics was found in non-dementia patients.Keywords: beers criteria, potentially inappropriate medication, dementia, older adults, Saudi Arabia

The almond tree, following the olive tree, holds the distinction of being the fruit species occupying the largest area in Morocco, spanning 128,000 ha and hosting 16 million trees. This sector holds immense socio-economic significance both nationally and globally. Despite its prominence, the almond tree faces severe phytosanitary challenges, prominently among them, the False tiger bug of the almond tree, Monosteira unicostata (Mulsant & Rey [Hemiptera: Tingidae]). This polyphagous, sedentary, and gregarious hemipteran, boasting five larval instars and typically generating four generations annually, exhibits a life cycle duration ranging from 2 to 3 months contingent on the season. This pest inflicts notable harm on almond tree leaves by extracting their chlorophyll content through its piercing mouthparts and depositing excrement, impeding respiratory function and adversely impacting fruit development, maturation, and overall production. Diverse control strategies have been implemented to tackle this issue, commencing with prophylaxis involving resistant varieties and sound agricultural practices. Subsequently, biological control methods leveraging natural enemies such as Piocoris luridus and species from families including Coccinellidae, Anthocoridae, Lygaeidae, Miridae, and Nabidae have been employed. Plant-based biopesticides such as azadirachtin (Azadirachta indica), thyme oil (Thymus zygis), Jatropha oil (Jatropha curcas), and concentrated extracts of Artemisia absinthium, as well as mineral-based approaches involving treated kaolin sprays through particle film technology, contribute to the arsenal of control measures. In cases of severe infestations, synthetic active ingredients such as organophosphates, pyrethroids, carbamates, abamectin, and deltamethrin, among others, have proven efficacy in managing this pest.

Madawi Alotaibi,1 Alanoud Alotaibi,1 Amani Alqahtani,1 Rand Alghonaim,1 Samira Alzahrani,1 Tala Altamimi,1 Doaa Aljasser,2 Samiah Alqabbani,1 Afrah Almuwais1 1Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 2Epidemiology and Biostatistics Section, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Afrah Almuwais, Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 25058, Riyadh, 11466, Saudi Arabia, Email Akalmuwais@pnu.edu.saPurpose: As the number of mental illnesses increases, there is a need to manage it holistically within a multidisciplinary team. The majority of patients with physical disabilities suffer from mental health problems, and physiotherapy can play a role in improving their lifestyle. This study aimed to determine physiotherapists’ self-reported knowledge and attitudes regarding their role in treating patients with mental health disorders.Methods: This study adopted a descriptive, cross-sectional, and prospective observational survey design. The sample consisted of 208 physical therapists.Results: The majority of the participants, (48%) had a positive attitude score, with (40%) having a neutral attitude and (12%) having a negative attitude toward treating patients with mental health issues. Most respondents (86%) reported that they need more information regarding patients with mental health disorders and physiotherapists’ management of their physical health issues.Conclusion: Many physiotherapists lack knowledge and hold a neutral to negative attitude towards treating patients with mental disorders. This highlights the need for more training to fill the gap in knowledge and guide physiotherapists to build upon their positive attitude towards treating patients with mental disorders.Keywords: physiotherapists, mental illness, mental health, psychosocial

In recent years, there has been a surge in the popularity of minor millets, also called ancient grains. As a result, there has been a growing interest in the potential health benefits and unique dietary properties that these foods offer. Once considered a forgotten crop, millet has gained popularity as part of efforts to achieve sustainable development goals. With a growing population, there is a need to explore sustainable methods to provide food and nutritional security to people, and millets offer a promising solution to this objective. This literature review aims to provide a thorough and all-encompassing overview of the geographical distribution of minor millets, as well as the challenges and opportunities associated with their production. Additionally, this review will investigate the nutritional benefits of minor millets and their potential for use in the development of value-added products.

Jithin K Sreedharan,1 Gokul Krishna Gopalakrishnan,2 Ann Mary Jose,2 Ibrahim Ahmad Albalawi,3 Mohammed Ghaithan Alkhathami,4 Keerthi N Satheesan,5 Musallam Alnasser,4 Meshal AlEnezi,4 Abdullah S Alqahtani4 1Department of Respiratory Therapy, College of Health Sciences, University of Doha for Science and Technology, Doha, Qatar; 2Department of Respiratory Care, Batterjee Medical College, Jeddah, Saudi Arabia; 3Advanced Centre for Clinical Simulation, Assistant Vice Dean of Academic Affairs, Prince Sultan Military College of Health Sciences, Dhahran, Dammam, Saudi Arabia; 4Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran, Dammam, Saudi Arabia; 5Department of Respiratory Care, Royal Medical Services College of Nursing and Health Sciences, Manama, BahrainCorrespondence: Jithin K Sreedharan, Department of Respiratory Therapy, College of Health Sciences, University of Doha for Science and Technology, Doha, Qatar, Email jithin.sreedharan@udst.edu.qa; jithinksree@gmail.comAbstract: Simulation-based pedagogy has become an essential aspect of healthcare education. However, there is a significant gap in the literature regarding the application of simulation-based modalities in respiratory care education. This review aims to address this gap by providing insight into the theory and current uses of simulation, its effectiveness in respiratory care education, and strategies to enhance faculty development. The study utilizes a narrative synthesis approach to review relevant literature and provide a comprehensive understanding of the topic. The research involved comprehensive searches of electronic databases, including PubMed and Google Scholar, to identify relevant literature, encompassing original articles, reviews, and other pertinent content, focusing on simulation-based teaching and learning in respiratory care education published between 1990 and 2022. Findings suggest that simulation-based education is an effective tool for improving respiratory care education and can enhance the clinical skills of learners. The study concludes by discussing the future of simulation in respiratory care education and the potential benefits it may offer.Keywords: simulation, learning, respiratory therapy, education, clinical simulation, medical simulator, clinical Skills

The magnetohydrodynamics tangent hyperbolic nanofluid (THNF) flow with the mutual impact of melting heat transfer and wedge angle over a permeable wedge is investigated numerically in the present study. Electronic devices generate excessive heat during operations, so THNF is often employed to regulate them. THNF has the ability to neutralize heat with greater efficacy, thereby reducing the probability of overheating. The influence of thermal radiation, Soret and Dufour, and heat source/sink is also observed on the fluid flow. The modeled equations are simplified to the lowest order through the similarity conversion. The obtained set of dimensionless equations is further calculated numerically by employing the parametric continuation method. The computational findings of the present study are compared to the published results for accuracy purposes. It has been detected that the results are precise and reputable. Moreover, from the graphical results, it has been perceived that the effect of permeability factor (K p) reduces the fluid flow. The rising effect of wedge angle factor enhances the energy dissemination rate and shearing stress; however the augmentation of Weissenberg number drops skin friction and energy transference rate.

Jithin Sreedharan,1 Arun Vijay Subbarayalu,2 Ajayan Kamalasanan,2 Ibrahim Albalawi,3 Gokul G Krishna,4 Ayedh Dhafer Alahmari,4 Jihad A Alsalamah,5 Mohammed G Alkhathami,6 Meshal Alenezi,6 Abdullah S Alqahtani,6 Mohammed Alahmari,7 Michael R Phillips,8 JoAnne MacDonald9 1Department of Respiratory Therapy, College of Health Sciences, University of Doha for Science and Technology, Doha, Qatar; 2Deanship of Quality & Academic Accreditation, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia; 3Simulation and Advanced Clinical Skills Center, Prince Sultan Military College of Health Sciences, Dhahran, Kingdom of Saudi Arabia; 4Department of Respiratory Care, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia; 5Department of Respiratory Care, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; 6Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran, Dammam, Kingdom of Saudi Arabia; 7Dammam Health Network, Eastern Health Cluster, Dammam, Kingdom of Saudi Arabia; 8Directorate of Applied Research, Innovation and Economic Development, University of Doha for Science and Technology, Doha, Qatar; 9Deanship - College of Health Sciences, University of Doha for Science and Technology, Doha, QatarCorrespondence: Jithin Sreedharan, Department of Respiratory Therapy, College of Health Sciences, University of Doha for Science and Technology, Doha, Qatar, Email jithinksree@gmail.com; jithin.sreedharan@udst.edu.qaBackground: Performance evaluation in the allied healthcare education sector is complex, making it essential for policymakers and managers to approach it comprehensively and thoughtfully to understand their performance. Hence, the development and monitoring of Key Performance Indicators (KPIs) in this domain must be considered one of the key priorities for the policymakers in AHIs.Aim: This study aims to develop a framework for the AHIs to extract and profile the indicators, measure, and report the results appropriately.Methods: The authors adopted a general review of the literature approach to study the primary goals of the institutional KPI framework, emphasizing the need for benchmarking while implementing KPIs and how to track performance using a KPI dashboard.Results: The study provides the scope, relevant KPI categories, and a list of KPIs for evaluating the effectiveness of allied healthcare programs. The study findings also emphasized the need for benchmarking the KPIs and establishing a KPI dashboard while measuring and monitoring performance.Conclusion: KPIs are considered an invaluable tool that contributes immensely to the performance monitoring process of AHIs, irrespective of the specialties. This helps to identify and guide AHIs for developing KPIs and the associated minimum data set to measure organizational performance and monitor the quality of teaching and learning. In addition, the KPI framework reported in this study is a tool to assist performance monitoring that can subsequently contribute to the overall quality of AHIs.Keywords: key performance indicators, allied healthcare institutions, performance assessment, KPI dashboard, KPI framework

Hanan Al Rayes,1 Norah AlOudah,1 Roaa Alsolaimani,2,3 Abdulrahman Alharthi,4 Mohammed Attar,4 Hassan Daghasi,4 Abdurahman Albeity,2 Afnan M Afifi,2 Abdulelah AlQahtani,1 Alya Alkaff,5 Sultan M Alkhamesi,3 Basant Elnady4,6 1Department of Rheumatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 2Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 3Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Rheumatology, Al Hada Armed Forces Hospital, Taif, Saudi Arabia; 5Obstetrics and Gynecology Department, King Faisal Specialist Hospital, and Research Center, Jeddah, Saudi Arabia; 6Rheumatology and Rehabilitation Department, Faculty of Medicine, Benha University, Benha, EgyptCorrespondence: Basant Elnady, Tel +966562387723, Email basantelnady@gmail.comObjective: The current study aimed to determine the pregnancy outcomes complications in patients with SLE and its association with clinical, laboratory variables, disease activity, and medication use in the Saudi population, as well as pregnancy effect on disease activity.Methods: A multicenter study included pregnant female patients with Systemic Lupus Erythematosus (SLE) from three tertiary centers in Saudi Arabia. The demographics, clinical, and laboratory variables, SLE disease activity index (SLEDAI), medication before, during, and after pregnancy, planned pregnancy, pregnancy-related outcomes, and complications in comparison to age-matched healthy female controls were noted.Results: A total of 66 pregnant patients with SLE and 93 healthy age-matched pregnant controls were included in the study. A total of 77.3% had SLEDAI-2K ≤ 4 before conception, and 84.85% of pregnancies were planned. Age of conception, cesarean section, miscarriage, and low birth weight were statistically significant (p < 0.05) higher in SLE patients than in healthy controls. Among all clinical and laboratory variables, SLEDAI-2K > 4 and active lupus nephritis during pregnancy were statistically associated with adverse outcomes (p < 0.05), history of lupus nephritis was not associated with statistically adverse pregnancy outcomes. Higher SLEDAI-2K > 4 was an independent risk at least 4.87 times higher association with adverse pregnancy outcomes. (p < 0.05).Conclusion: SLE is intricately connected with unfavorable pregnancy outcomes. The preconception of high disease activity stands as a pivotal risk factor for adverse outcomes. Despite the disease remission and meticulous planning, SLE patients frequently grapple with disease exacerbations during pregnancy, culminating in unexpected and unfavorable pregnancy-related outcomes. This underscores the intricate and multifaceted nature of managing SLE during gestation.Keywords: systemic lupus erythematosus, pregnancy, disease activity

Multiple beneficial effects have been reported to numerous species of Capparis genus. Among these, Capparis spinosa has exhibited several biological benefits, including anti-inflammatory hepatoprotective, antioxidant, and antidiabetic effects. Herein, C. spinosa was extracted with different solvents and the ability of these fractions to suppress nitric oxide (NO) production in RAW 264.7 cells were assessed via Griess reagent. The effects of C. spinosa fractions on different inflammatory markers were also determined in THP-1 and Human umbilical vein endothelial cells (HUVEC) using reverse transcription polymerase chain reaction. Additionally, high-performance liquid chromatography (HPLC) ultra-violet was employed to estimate the presence of three flavonoid compounds, namely, apigenin, kaempferol, and rutin. Our results indicate that chloroform (CHCl3) and ethyl acetate (EtOAc) fractions of C. spinosa exhibited a promising anti-inflammatory activity via in vitro inhibition of NO in lipopolysaccharide stimulated RAW 264.7 cells. Pretreated stimulated THP-1 cells with either CHCl3 or EtOAc fractions showed decreased expression of interleukin 1 beta (IL-1β) and tumor necrosis factor Alpha in a dose-dependent manner. In HUVEC cells, both fractions downregulate the expression of IL-1β, upregulate the peroxisome proliferator-activated receptor alpha PPAR-α while no significant impact was observed on PPAR-ϒ gene expression. The presence of apigenin, kaempferol, and rutin in the crude extract has been confirmed through HPLC method. Collectively, these results support the ethnopharmacological usage of C. spinosa as a potential therapy for inflammation related conditions including atherosclerosis.

Maize (Zea mays L.) is known to be one of the current crops with wide adaptability and the potential to grow in various agroecological zones. It has been titled as “queen of cereals” group owing to its high genetic yield capability and abundance among the cereal crop. This study highlights the nutritive composition, phytochemical composition, pharmaceutical properties, and the unconventional use (like ethanol production) of maize plant parts such as the husk, silk, and cob, along with their utilisation in the food sector and pharmaceutical industries. Apart from the kernels, bulk of the harvest, if not used as manure, is majorly treated as waste and is usually discarded. Maize can be incorporated and utilised in the waste management of crop residues. The industrial significance of the maize crop is unmatched when compared to other cereal crops and it is used as a raw material for over 3,000 products in various sectors namely, sweeteners, cosmetics, textiles, gum, alcoholic beverages, films, package, and paper industries. Each part of the maize plant is rich in macronutrients (carbohydrates and proteins) and micronutrients (vitamins and minerals) along with other phytochemical constituents due to which it has an immense scope to be used in value-added products providing various pharmacological properties.

This study aims to contribute to the valorizing of aromatic and medicinal plants of Morocco by studying the antioxidant and antifungal properties of the essential oils (EOs) of Allium sativum (AS) (garlic) and Urginea maritima (Syn. Drimia maritima) tested in vitro. After the hydrodistillation of EOs, we determined their physicochemical indices according to an international standard (Moroccan ISO standard), and the chemical composition of the oils was studied by gas chromatography coupled with mass spectrometry (GC-MS). Then, the antioxidant properties were determined using the free radical scavenging capacity of 2,2-diphenyl-1-picrylhydrazyl and the ferric-reducing antioxidant power of these oils. The evaluation of the antifungal activity was carried out by the direct contact method against two fungal strains, Fusarium oxysporum and Fusarium equiseti. GC-MS analysis revealed a significant percentage of terpenes in U. maritima EO, with terpinolene (21.82%) and estragole (6.24%) as the main compounds. Biological tests have demonstrated the remarkable antioxidant activities of this EO compared with AS EO, with an IC50 of 1.03 mg/mL and an RP0.5 of 1.60 mg/mL. On the other hand, while A. sativum (garlic) EO showed exceptional antifungal activities, with 100% inhibition and MICs of 0.5 µL/mL for F. equiseti and 2.5 µL/mL for F. oxysporum. Also, regardless of its antioxidant properties being moderate, this EO stands out for its efficacy against fungal infections of the Fusarium genus. In summary, the results suggest that U. maritima EO could be used as a natural source of antioxidants, while garlic EO could be considered a potentially effective treatment against fungal infections caused by Fusarium fungi.

Objective(s): The present study evaluated the protein-based analysis to unravel the role and mechanism behind the Dendropthae falcata plant extract treatment in breast cancer cells. Materials and Methods: The protein sample was extracted from the cancer cells after treatment with the plant extract and subjected to two-dimensional electrophoresis for protein separation. Further, the proteins that were differentially regulated among the samples which were treated and non-treated were selected and processed further for protein identification using a tandem mass spectrometry approach.Results: Using these strategies, we identified 16 potential candidates which were showing remarkable changes in treated samples. All the candidates were analyzed further for gene ontology analysis, and it was observed that all proteins were involved in multiple pathways pertaining to the carcinogenesis process. Specifically, apoptotic pathway proteins including BAD, BIK, BID, CASP8, MCL1, BCL2, and BAK1 were highly impacted by treatment with D. falcata plant extract. All these protein hits were further taken for validation experiments using RT PCR analysis. Conclusion: Initiation of these apoptotic proteins by D. falcata plant extract treatment in breast cancer cells shows a positive direction toward nature-based alternative medicine.

Colorectal cancer remains a challenging medical issue worldwide, and utilizing natural products and plants to produce novel, effective and safe therapies against this disease is continuously a sought-after strategy. Fruit and leaf extracts of Pithecellobium dulce (P. dulce) showed potential anticancer properties as they induced apoptosis of breast cancer and Dalton’s lymphoma ascites cells. Thus, the main objective of the current study is to determine whether the seed extract of P. dulce will affect apoptosis, cell cycle, migration, and inflammation of LoVo colorectal cancer cells. The high-resolution liquid chromatography–mass spectrometry was used to determine the chemical composition of the P. dulce seed extract, which revealed the presence of 35 phytochemicals. The findings of this study indicated a significant cytotoxic effect of seeds of this plant in colorectal cancer characterized by induction of apoptosis, cell cycle arrest, and reduction of migration. In addition, the seed extract suppressed several genes that are essential for cancer progression such as MMP2, MMP9, and IL-8, and, on the other hand, upregulated pro-apoptotic genes such as BAX and P53. This study has established P. dulce as a potential and valuable source for providing future therapies against colorectal cancer and other cancers.

This study aimed to comprehensively assess the phytochemical composition, employing gas chromatography–mass spectrometry (GC–MS) and reverse-phase high-performance liquid chromatography (RP-HPLC) analyses, molecular docking, ADMET analysis, and antioxidant activity evaluation, of three Solanum species (Solanum forsskalii [SF], Solanum villosum [SV], and Solanum incanum [SI]) from the diverse flora of Saudi Arabia. Two solvents, hydro-methanolic (HME) and hydro-acetonic extract, were utilized for extraction, finding HME more efficient, especially for SV. GC–MS analysis identified diverse compounds, with palmitic acid, linoleic acid, methyl palmitate, cis-13-octadecenoic acid, and oleic acid as the main constituents. RP-HPLC quantified 12 phenolic compounds, identifying chlorogenic acid, rutin, and p-coumaric acid as abundant. Antioxidant assays showed HME extracts to be more effective in both diphenyl 1-picrylhydrazyl and ABTS assays, with SV exhibiting the strongest antioxidant effect, followed by SF and SI. Pearson correlation analysis indicated a positive correlation between phenolic content and antioxidant activity (r = 0.6067–0.8927). Molecular docking simulations demonstrated robust binding energies between predominant compounds and Cyt-c, underscoring their potential as effective antioxidants. ADMET analysis showcased varied profiles, suggesting promising pharmaceutical prospects. This study explores the phytochemical profiles of these Solanum species, emphasizing their strong antioxidant capacity as natural sources of phenolic compounds, advancing our understanding of their promising medicinal applicability.

The primary goal of this work was to develop a cost-effective, non-toxic, eco-friendly, and simple approach for the green synthesis of CoFe2O4 nanoparticles (NPs) using Aloe vera leaf extract by the sol–gel auto-combustion method. In order to figure out their structural, morphological, and magnetic properties, the synthesized NPs were characterized using X-ray diffraction (XRD), Fourier transform infrared (FTIR), scanning electron microscope (SEM), energy-dispersive X-ray spectroscopy (EDX), transmission electron microscope (TEM), dynamic light scattering (DLS), zeta potential, and vibrating-sample magnetometer (VSM). XRD analysis showed that particles had a single-phase spinel crystalline structure with an average crystalline size of 33.5 nm. Under VSM studies, the produced NPs exhibit a soft ferromagnetic property. SEM revealed that the as-prepared NPs were agglomerated due to their magnetic behavior. To the best of our knowledge, the anticandidal, antibiofilm, antibacterial, and anticancer activities of CoFe2O4 NPs toward drug-resistant gram-positive and gram-negative bacteria, as well as fungal strains, have been comprehensively investigated for the first time. The synthesized NPs had a minimal inhibitory concentration of 0.25–0.75 mg/ml against the tested pathogens. CoFe2O4 NPs inhibited the biofilm formation by 37.3–61.8% in selected strains at concentrations of 0.125–0.5 mg/ml. It was observed that the NPs not only suppress biofilm formation but also eradicate established mature biofilms by 50.9–64.49% that was further supported by SEM. SEM analysis shows that NPs significantly inhibit the colonization and aggregation of tested biofilm strains. Light microscopic analysis revealed that NPs completely inhibit the development of hyphae and filaments in Candida albicans, which significantly attenuates their pathogenicity. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays and 4′,6-diamidino-2-phenylindole (DAPI) staining demonstrate that NPs significantly inhibit the proliferation of HCT-116 and HeLa cells. Furthermore, the SEM images of treated cells showed wrinkled and damaged cell walls, indicating the disruption and disorganization of the membrane. This study showed that the synthesized NPs were effective in inhibiting the growth of drug-resistant bacteria, candida, and their preformed biofilms as well. Thus, these NPs with broad-spectrum applications could be exploited in medical settings to diminish biofilm-based infections caused by these pathogenic strains.

The current natural extract modalities for colorectal cancer are limited. This research seeks to assess the process of extracting the plant’s bioactive constituents from Cassia angustifolia and to show the anticancer role played by the plant’s aqueous extract at 0°C by identifying the genes that alter in expression after the Cassia angustifolia treatment in colon cancer cells. The bioactive components of Cassia angustifolia extract were revealed using gas chromatography-mass spectrometry analysis. The colon carcinoma cell lines (SW480) were treated with Cassia angustifolia macrophages at concentrations of 50, 150, and 200 µg/mL for 48 h. Apoptosis was examined by fluorescence-activated cell sorting analysis of Cassia angustifolia-treated and -untreated cells. Microarray analysis was performed by using human microarray chips (HG-U95A) for untreated and treated SW480 cells. Microarray data were confirmed by the reverse transcription polymerase chain reaction. The findings showed that the Cassia angustifolia aqueous extract at 0°C/24 h contained the entire absolute phenolic content of 28.43 mg/g and the entire absolute flavonoid content of 9.16 mg/g. Cassia angustifolia enhanced the hindrance of cell development and apoptosis and decreased glucose uptake. Western blot analysis showed induction in the expression of cleaved caspases 3 and 9 in SW480 cells. Microarray data identified 11 genes and 7 expressed sequence tags (ESTs) markedly altered in treated vs non-treated SW480 cells. Several of these genes have been embroiled in multiple malignancies. In conclusion, the current study provides remarkable new data for Cassia angustifolia extracted at 0°C/24 h. We discovered 7 ESTs and 11 genes that are significantly altered in the progression of SW480 cells treated with Cassia angustifolia therapy versus no treatment, with anticancer and apoptosis inducer effects.

Mohsin Kazi,1 Muhammad Farooq Khan,2 Fahd A Nasr,3 Mohammad Z Ahmed,3 Ali S Alqahtani,3 Meser M Ali,4 Mohammed S Aldughaim5 1Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia; 2Department of Zoology, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia; 3Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia; 4Department of Neurosurgery, Henry Ford Health, Detroit, MI, 48202, USA; 5Research Center, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, 11525, Kingdom of Saudi ArabiaCorrespondence: Mohsin Kazi; Mohammed S Aldughaim, Email mkazi@ksu.edu.sa; maldughaim@kfmc.med.saPurpose: Curcumin (CUR) and piperine (PP) are bioactive compounds with prominent pharmacological activities that have been investigated for the treatment of various diseases. The aim of the present study is to develop Bio-SNEDDS for CUR and PP as a combined delivery system for cancer therapy.Methods: CUR and PP loaded Bio-SNEDDSs with varying compositions of bioactive lipid oils, surfactants, and cosolvents were prepared at room temperature. Bio-SNEDDSs were characterized using a Zetasizer Nano particle size analyzer and further examined by transmission electron microscopy (TEM) for morphology. The in vivo toxicity of the preparations of Bio-SNEDDS was investigated in wild-type zebrafish embryos and cytotoxicity in THP-1 (human leukemia monocytic cells), Jurkat (human T lymphocyte cells) and HUVEC (non-cancerous normal) cells.Results: Bio-SNEDDSs were successfully developed with black seed oil, Imwitor 988, Transcutol P and Cremophor RH40 at a ratio of 20/20/10/50 (%w/w). The droplet size, polydispersity index and zeta potential of the optimized Bio-SNEDDS were found to be 42.13 nm, 0.59, and − 19.30 mV, respectively. Bio-SNEDDS showed a spherical structure evident by TEM analysis. The results showed that Bio-SNEDDS did not induce toxicity in zebrafish embryos at concentrations between 0.40 and 30.00 μg/mL. In TG (fli1: EGFP) embryos treated with Bio-SNEDDS, there was no change in the blood vessel structure. The O-dianisidine staining of Bio-SNEDDS treated embryos at 48 h post-fertilization also showed a significant reduction in the number of blood cells compared to mock (DMSO 0.1% V/V) treated embryos. Bio-SNEDDS induced significant levels of cytotoxicity in the hematological cell lines THP-1 and Jurkat, while low toxicity in normal HUVEC cell lines was observed with IC50 values of 18.63± 0.23 μg/mL, 26.03 ± 1.5 μg/mL and 17.52 ± 0.22 μg/mL, respectively.Conclusion: Bio-SNEDDS exhibited enhanced anticancer activity and could thus be an important new pharmaceutical formulation to treat leukemia.Graphical Abstract: Keywords: curcumin, piperine, bioactive self-nanoemulsifying drug delivery systems, leukemia, combination therapy

Jaber S Alqahtani,1 Abdulelah M Aldhahir,2 Zaid Alanazi,3 Emad Zahi Alsulami,4 Mujahid A Alsulaimani,5 Abdullah A Alqarni,6 Abdullah S Alqahtani,1 Ayadh Yahya AlAyadi,1 Musallam Alnasser,1 Ibrahim A AlDraiwiesh,1 Saeed M Alghamdi,7 Hussam M Almarkhan,1 Abdullah S Alsulayyim,2,8 Saad M AlRabeeah,1 Mohammed D AlAhmari1 1Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 2Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia; 3Family Medicine Department, Northern Area Armed Forces Hospital (NAAFH), Hafar Al Batin, Saudi Arabia; 4Family Medicine Department, Armed Forces Hospital in King Abdulaziz Airbase, Dhahran, Saudi Arabia; 5Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 6Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 7Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, 24382, Saudi Arabia; 8National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UKCorrespondence: Jaber S Alqahtani, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia, Email Alqahtani-Jaber@hotmail.comBackground: Smoking behavior has been associated with poor academic performance among adult students worldwide. However, the detrimental effect of nicotine dependence on several students’ academic achievement indicators is still unclear. This study aims to assess the impact of smoking status and nicotine dependence on grade point average (GPA), absenteeism rate and academic warnings among undergraduate health sciences students in Saudi Arabia.Methods: A validated cross-sectional survey was conducted, in which, participants responded to questions evaluated cigarette consumption, urge to consume and dependency, learning performance, days of absentees, and academic warnings.Results: A total of 501 students from different health specialties have completed the survey. Of whom, 66% were male, 95% ranging between the age of 18– 30 years old, and 81% reported no health issues or chronic diseases. Current smokers estimated to be 30% of the respondents, of which 36% revealed smoking history of 2– 3 years. The prevalence of nicotine dependency (high to extremely high) was 50%. Overall, smokers had significantly lower GPA, higher absenteeism rate, and higher number of academic warnings when compared to nonsmokers (p< 0.001). Heavy smokers demonstrated significantly less GPA (p=0.036), higher days of absences (p=0.017), and more academic warnings (p=0.021) compared to light smokers. The linear regression model indicated a significant association between smoking history (increased pack-per-year) and poor GPA (p=0.01) and increased number of academic warning last semester (p=0.01), while increased cigarette consumption was substantially linked with higher academic warnings (p=0.002), lower GPA (p=0.01), and higher absenteeism rate for last semester (p=0.01).Conclusion: Smoking status and nicotine dependence were predictive of worsening academic performance, including lower GPA, higher absenteeism rate and academic warnings. In addition, there is a substantial and unfavorable dose–response association between smoking history and cigarette consumption with impaired academic performance indicators.Keywords: smoking, nicotine dependence, academic performance, health sciences, student

Jithin K Sreedharan,1 Manjush Karthika,2 Jaber S Alqahtani,1 Saad M AlRabeeah,1 Musallam Alnasser,1 Abdullah S Alqahtani,1 Mohammed D AlAhmari,1 Arulanantham Zechariah Jebakumar,3 Meshal AlEnezi,1 Abdullah A Ghazwani,1 Chris Sara Mathew,2 Abdulelah M Aldhahir,4 Suresh G Nair5 1Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 2Respiratory Care, Department of Health and Medical Sciences, Khawarizmi International College, Abu Dhabi, United Arab Emirates; 3Vice Deanship of Postgraduate Studies and Research, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 4Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 5Department of Anesthesiology and Critical Care Medicine, Aster Medicity, Kochi, Kerala, IndiaCorrespondence: Jithin K Sreedharan, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia, Email jithinksree@gmail.comBackground: Lung Ultrasound (LUS) had proved to be beneficial in detecting respiratory disorders at the bedside. Understanding the important role of Respiratory Therapists (RTs) in the critical care, we aimed to assess their knowledge, perceived relevance of LUS to clinical practice, current skill gaps, and barriers to practice.Methods: A cross-sectional, nationwide survey conducted among the RTs working in the Kingdom of Saudi Arabia. The validated questionnaire included 4 sections; the demographics, knowledge and perceptions, applicability and self-reported proficiency, and barriers to the use of LUS by RTs.Results: A total of 256 RTs across different regions of Saudi Arabia participated in this survey. 71.9% of them were males, and 46.1% of the participants were having < 5 years of working experience. Only (18.1%) of the participants used LUS in their clinical practice, and (43%) of them had never received any training. 66% of the participants perceived LUS as an effective tool in the RT practice and immensely valuable in their daily practice (70%). A large proportion of RTs perceived LUS to be ineffective in calculating the lung score (50.4%), assessing the diaphragm (40.2%), and detecting pulmonary edema (38.3%). Calculating lung score has a lower mean score of 2.55 on both skills, and identifying its applicability to clinical practice with a mean score of 2.71 than other indications. Lack of training and curriculum (154/256; 60.2%) remains the top barrier that prevented RTs from using LUS in their clinical practice.Conclusion: While many RTs in Saudi Arabia perceived LUS as an effective tool in the RT practice, considerable competence gap exist, indicating the need for LUS training. There is a need for incorporating LUS into the curriculum of RT schools and promoting competency-based training for the current RT workforce to help improve patient care.Keywords: lung ultrasound, respiratory therapy, curriculum, training

Jaber S Alqahtani,1 Mohammed D AlAhmari,1,2 Hajed M Al-Otaibi,3 Saad M AlRabeeah,1 Noor A Al Khathlan,4 Abdulelah M Aldhahir,5 Abdullah S Alqahtani,1 Khalid S Alwadeai,6 Saleh S Algarni,7,8 Rayan A Siraj,9 Abdullah A Alqarni,3 Mohammed A Almeshari,6 Saeed M Alghamdi,10 Mohammed AlTaweel,11 Musallam Alnasser,1 Jithin K Sreedharan,1 Abdullah A Almojaibel,4 Mushabbab Alahmari,12 Yousef S Aldabayan,9 Bodor H Bin Sheeha,13 Fahad H Alahmadi,14 Abdullah S Alsulayyim,5,15 Eidan M Alzahrani16 1Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia; 2Dammam Medical Complex, Dammam Health Network – Eastern Health Cluster, Dammam, 32245, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 4Respiratory Care Department, Imam Abdulrahman bin Faisal University, Dammam, 34212, Saudi Arabia; 5Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia; 6Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 11451, Saudi Arabia; 7Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, 14611, Saudi Arabia; 8King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 9Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, 31982, Saudi Arabia; 10Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, 24382, Saudi Arabia; 11Respiratory Care Department, AlMaarefa University, Riyadh, 13713, Saudi Arabia; 12Department of Respiratory Therapy, Faculty of Applied Medical Sciences, University of Bisha, Bisha, 67714, Saudi Arabia; 13Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11564, Saudi Arabia; 14Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Madinah, 42353, Saudi Arabia; 15National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK; 16Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi ArabiaCorrespondence: Jaber S Alqahtani, Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia, Email Alqahtani-Jaber@hotmail.comBackground: Despite recent advancements in the respiratory care (RC) profession, no single institution in the Kingdom of Saudi Arabia (KSA) offers a master’s degree program in RC.Methods: A nationwide and validated survey was used to explore the current needs and interests in establishing RC master’s degree programs in the KSA. The process included representatives from the healthcare industry, universities, and professional societies.Results: A total of 1250 stakeholders across the KSA completed the survey. The sample includes 722 (58%) males, 504 (40%) respiratory therapists, 547 (44%) students, 138 (11%) leaders, and 61 (5%) were academic respondents. Most respondents were from Central 491 (39%) and Eastern 307 (25%) regions, with 1003 (80%) of the total sample worked or studied in governmental sectors. A total of 574 (82%) of the leaders and RTs had Bachelor degree and 430 (61%) of them had 1– 5 years working experience. According to 80% of the employers and employees, only 0– 5% of the RTs in their organization had a master’s degree. The calculated mean % of the agreement (agree/strongly agree) on the needs was 83% in all needs’ assessment items, which shows a great support for establishing a master’s in RC to meet the personal, professional and society needs. The mean % of the agreement for the level of interests among all participants was 86%, indicating a great level of interests in establishing a master degree in RC. The agreement % on the needs assessment and level of interests in establishing a master degree in RC in KSA were ≥ 80% in each stakeholder group.Conclusion: There are obvious needs and interests in establishing master’s degree programs in RC in the KSA. A master’s degree in RC should be established to address the growing needs for advanced RC services throughout the nation and enhance RC research.Keywords: respiratory care, master degree, education, Saudi Arabia, NCAAA, accreditation

This study explores the educational methodologies employed by Saudi English as a foreign language (EFL) teacher, with a specific emphasis on contrasting teacher-centered approaches and student-centered approaches. Additionally, the research examines the teachers' personal beliefs regarding the most effective approach for implementation in EFL classrooms. To gather data, an online questionnaire was administered to 42 EFL teachers across Saudi K-12 schools in the Southern part of Saudi Arabia. The questionnaire comprised two sections: a demographic information segment and an inquiry into teachers' perspectives and practices. The results of the study showed a dichotomy. While a majority of participants professed that both teacher-centered and student-centered methodologies carry equal importance, a more nuanced picture emerged when examining their claimed practices versus actual classroom behavior. The majority of EFL K-12 instructors in Saudi classrooms leaned toward adopting teacher-centered approaches. These findings hold significant implications for EFL teacher training and professional development courses. This may be due to teachers' lack of confidence in implementing student-centered approaches, the traditional educational culture in Saudi Arabia, or pressure to prepare students for high-stakes exams. The study suggests that teacher education programs should focus on developing teachers' understanding and confidence in using student-centered approaches and that the Ministry of Education should create a more supportive environment for student-centered teaching approaches.

Cardiovascular disease (CVD) represents the leading cause of mortality worldwide. In order to diagnose CVDs, there are a range of detection methods, among them, the impedance cardiography technique (ICG). It is a non-invasive and low-cost method. In this paper, we highlight recent advances and developments of the CDVs diagnosis mainly by the ICG method. We considered papers published during the last five years (from 2017 until 2022). Based on this study, we expressed the need for an ICG database for the different CDVs.

Sultan M Alshahrani,1 Khalid Orayj,1 Ali M Alqahtani,2 Adel Alfatease,3 Atheer Alshahrani,4 Ahmed RN Ibrahim1,5 1Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Pharmacology Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 3Pharmaceutics Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 4Alnahdi Pharmacies, Khamis Mushait, Saudi Arabia; 5Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, EgyptCorrespondence: Ahmed RN Ibrahim, Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia, Tel +966 554088979, Email aribrahim@kku.edu.saIntroduction: Community pharmacists play a key role as vaccinators for COVID-19. They can reduce the burden of the disease worldwide.Objective: This study used a cross-sectional questionnaire to determine whether the Saudi Arabian public was willing to obtain the COVID-19 vaccine via community pharmacists.Results: The questionnaire focused on the satisfaction, concerns, and opinions towards providing vaccination by community pharmacists. The study featured 415 individuals aged 18 and older (eligible for the COVID-19 vaccine). Of the participants in this study, 58.1% were aged 18– 25, with 55.4% female. Most participants (72.8%) have not been exposed to COVID-19 and are not aware of the approval of COVID-19 vaccination by community pharmacists. Of the 415 complete questionnaires, 45% believed that community pharmacists are not experienced in administering vaccines. However, 63% of participants are satisfied with getting the COVID-19 vaccination by a community pharmacist if no other option is available. More than 68% of the respondents agree that community pharmacies should expand their health care services to include vaccinations, prescriptions, checkups, and other forms of preventative medicine.Discussion: The availability of community pharmacist-administered vaccination in Saudi Arabia could be a significant factor in the success of the country’s vaccination program. This study may serve as a model to expand the role of pharmacists in other countries’ vaccination programs.Keywords: SARS-CoV-2, community pharmacy, immunization, perspective, adherence, patient satisfaction

Walid A Alkeridy,1– 3 Arwa Aljasser,4 Khalid Mohammed Alayed,1 Saad M Alsaad,5 Amani S Alqahtani,6 Claire Ann Lim,7 Sultan H Alamri,8,9 Doaa Zainhom Mekkawy,1 Mohammed Al-Sofiani1,10 1Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, Canada; 3General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh, Saudi Arabia; 4Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 5Department of Family & Community medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 6Research department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia; 7Department of Medical Rehabilitation, King Saud Medical City, Riyadh, Saudi Arabia; 8Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 9Saudi Geriatrics Society, Riyadh, Saudi Arabia; 10Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USACorrespondence: Walid A Alkeridy, West College of Medicine Building, 3rd Floor, Riyadh, Riyadh, 12372, Saudi Arabia, Tel +966118066802, Email walkeridy@ksu.edu.saObjective: This study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users.Design: Retrospective cross-sectional descriptive study.Setting and Participants: A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022.Methods: Only individuals fulfilling the HHC program’s eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients.Results: The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of < 0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis.Conclusions and Implications: In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.Keywords: home health care, Saudi Arabia, predictors of mortality

Ibrahim Albawardi,1 Abdullah H Alqahtani,1 Dana A Aljamea,2 Sara A Aljaafari,2 Fajar A Aldulijan,2 Seereen R Almuhaidib,2 Mohamed Elamin,3 Nourah H Al Qahtani4 1Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Biochemistry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Obstetrics and Gynecology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Ibrahim Albawardi, King Fahad University Hospital, Office 155, Building 200, Alburaq Street, Alkhobar, Saudi Arabia, Tel/Fax +966138966877. Ex.: 1554, Email imbawardi@iau.edu.saPurpose: To estimate the prevalence of depression amongst hormonal and non-hormonal contraception users, and the risk factors associated with depression in the sample.Patients and Methods: This is a community-based cross-sectional study conducted in the Kingdom of Saudi Arabia from October to November 2021, covering all regions of Saudi Arabia. All participants were women, living in Saudi Arabia, ≥ 21 years old and ≤ 45 years old, using a contraceptive method, and with no established history of depression.Results: A total of 4853 out of 18,596 met our criteria and were included in this study. Among all sample groups, 29% had moderate to severe depression. Rates of depression and association studies’ results in women using hormonal were higher than those who use non-hormonal birth control methods. Psychiatric disorders, medical illnesses, substance use and depressogenic medication use were all associated with depression in both hormonal and non-hormonal contraception users.Conclusion: The current study shows high prevalence of depression amongst hormonal contraceptive users compared to non-hormonal contraceptive users.Keywords: hormonal contraception, non-hormonal contraception, depression, psychiatric disorders

Haney Alsleem,1 Abdulrahman Tajaldeen,1 Abdulrahman Almutairi,2 Hussain Almohiy,3 Ebtisam Aldaais,1 Rayan Albattat,2 Mousa Alsleem,4 Elfatih Abuelhia,1 Osama Abdalla Mabrouk Kheiralla,1 Ahmed Alqahtani,5 Salem Alghamdi,6 Rowa Aljondi,6 Renad Alharbi7 1Department of Radiological Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Medical Imaging Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia; 3Radiological Sciences, King Khalid University, Abha, Saudi Arabia; 4College of Dentistry, King Faisal University, Alahsa, Saudi Arabia; 5Radiology Department, King Saud Medical City, Riyadh, Saudi Arabia; 6Department of Applied Radiologic Technology, University of Jeddah, Jeddah, Saudi Arabia; 7Department of Radiology, Specialized Medical Complex, Jeddah, Saudi ArabiaCorrespondence: Haney Alsleem, Email hsleem@iau.edu.saBackground: Iterative reconstruction algorithm (IR) techniques were developed to maintain a lower radiation dose for patients as much as possible while achieving the required image quality and medical benefits. The main purpose of the current research was to assess the level and usage extent of IR techniques in computed tomographic (CT) scan exams. Also, the obligation of practitioners in several hospitals in Saudi Arabia to implement IR in CT exams was assessed.Material and Methodology: The recent research was based on two studies: data collection and a survey study. Data on the CT scan examinations were retrospectively collected from CT scanners. The survey was conducted using a questionnaire to evaluate radiographers’ and radiologists’ perceptions about IR and their practices with IR techniques. The statistical analysis results were performed to measure the usage strength level of IR methods.Results and Discussions: The IR strength level of 50% was selected for nearly 80% of different CT examinations and patients of different ages and weights. About 46% of the participants had not learned about IR methods during their college studies, and 54% had not received formal training in applying IR techniques. Only 32% of the participants had adequate experience with IR. Half of the participants were not involved in the updating process of the CT protocol.Conclusion: The results indicate that the majority of radiographer and radiologist at four different hospitals in Saudi Arabia have no explicit or understandable knowledge of selecting IR strength levels during the CT examination of patients. There is a need for more training in IR applications for both radiologists and radiographers. Training sessions were suggested to support radiographers and radiologists to efficiently utilize IR techniques to optimize image quality. Further studies are required to adjust CT exam protocols effectively to utilize the IR technique.Keywords: computed tomography, CT, filter back projection, FBP, iterative reconstruction algorithms, IR, as low as reasonably achievable, ALARA

Mohammed Y Alhabib,1,&ast; Taha S Alhazmi,1 Saad M Alsaad,1,&ast; Alhanouf S AlQahtani,2 Aisha A Alnafisah3 1Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Aribia; 2General Administration of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Aribia; 3Department of Clinical Pharmacy, College of Pharmacy, Riyadh, King Saud University, Riyadh, Saudi Aribia&ast;These authors contributed equally to this workCorrespondence: Saad M Alsaad, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Aribia, Tel +966505493944, Email salsaad@ksu.edu.saBackground: Medication non-adherence is a common and significant public health problem, especially among the geriatric population. This study’s objective was to measure medication adherence and associated factors among geriatric patients with chronic diseases.Methods: A cross-sectional study targeted outpatient geriatrics who suffer from chronic diseases at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Telephone interviews were utilized to collect data from participants using a structured questionnaire and the GMAS validated instrument scale (General Medication Adherence Scale) intended to measure important determinants impacting adherence: patient behaviour, cost, comorbidity, and pill burden.Results: A total of 422 patients were assessed for medication adherence. The Mean overall score for GMAS was 29.9± 3.1 out of 33. (64.9%) of the patients had a high level of medication adherence. The patients had a high adherence on the domain of patient behavior related non-adherence (PBNA) (13.5± 1.9) out of 15, a high adherence on the domain of additional disease and pill burden (ADPB) (11.2± 1.4) out of 12, and good to high adherence on the cost-related non-adherence (CRNA) (5.25± 1.1) out of 6.Conclusion: The geriatric population with chronic diseases in our study had a good level of adherence to medication if compared with other international figures. To promote better medication adherence, patients must have a good understanding of their disease and strong beliefs about the medications prescribed.Keywords: frailty, older patients, hospitalized, prevalence, Saudi Arabia

Abdelrahman Y Sherif,1,2 Gamaleldin I Harisa,1– 3 Fars K Alanazi,1,2 Fahd A Nasr,4 Ali S Alqahtani4 1Kayyali Chair for Pharmaceutical Industry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 2Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 3Department of Biochemistry and Molecular Biology, College of Pharmacy, Al-Azhar University, Nasr City, Cairo, Egypt; 4Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Abdelrahman Y Sherif, Tel +966 500859725, Email ashreef@ksu.edu.saPurpose: The present study aimed to develop gefitinib-loaded solid lipid nanoparticles (GEF-SLN), and GEF-loaded PEGylated SLN (GEF-P-SLN) for targeting metastatic lung cancer through the lymphatic system.Methods: The prepared SLNs were characterized in terms of physicochemical properties, entrapment efficiency, and in-vitro release. Furthermore, ex-vivo permeability was investigated using the rabbit intestine. Cytotoxicity and apoptotic effects were studied against A549 cell lines as a model for lung cancer.Results: The present results revealed that the particle size and polydispersity index of the prepared formulations range from 114 to 310 nm and 0.066 to 0.350, respectively, with negative zeta-potential (− 14 to − 27.6). Additionally, SLN and P-SLN showed remarkable entrapment efficiency above 89% and exhibited sustained-release profiles. The permeability study showed that GEF-SLN and GEF-P-SLN enhanced the permeability of GEF by 1.71 and 2.64-fold, respectively, compared with GEF suspension. Cytotoxicity showed that IC50 of pure GEF was 3.5 μg/mL, which decreased to 1.95 and 1.8 μg/mL for GEF-SLN and GEF-P-SLN, respectively. Finally, the apoptotic study revealed that GEF-P-SLN decreased the number of living cells from 49.47 to 3.43 when compared with pure GEF.Conclusion: These results concluded that GEF-P-SLN is a promising approach to improving the therapeutic outcomes of GEF in the treatment of metastatic lung cancer.Graphical Abstract: Keywords: solid lipid nanoparticles, PEGylated SLN, intestinal permeability, gefitinib, cytotoxicity, apoptosis

Dodonaea viscosa (Sapindaceae) was collected from Riyadh, Saudi Arabia. For the simultaneous measurement of quercetin and kaempferol, a validated high-performance thin-layer chromatography (HPTLC) approach was devised in D. viscosa leaf extract. The antioxidant activity was evaluated using diphenyl 1-picrylhydrazyl (DPPH) and 2,2′-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) assays. Moreover, the cytotoxic effect was tested against three cancer cell lines A549, HepG2, and MDA-MB-231. The potential anti-inflammatory properties of different fractions of D. viscosa were also evaluated using lipopolysaccharide (LPS)-induced THP-1 macrophages cells. The test samples include a crude extract of leaves and its solvent-soluble fractions of D. viscosa. The results showed that the crude extract and its fractions exhibited various significant biological activities, the fraction of chloroform demonstrated the highest free radical scavenging activity with IC50 values: 172.2 and 257.7 µg/mL for both DPPH and ABTS tests. Additionally, the chloroform fraction had the greatest cytotoxic activity against MDA-MB-231 (IC50 values: 24.6 ± 0.4 µg/mL). Moreover, the chloroform fraction exhibited the highest downregulation of the LPS-induced expression of TNF-α and IL-6. Quercetin and kaempferol were estimated concurrently in leaves crude extract using a validated technique on an HPTLC plate (10 cm2 × 10 cm2) with a combination of toluene–ethyl acetate–formic acid (5:4:0.2; v/v/v) as the mobile phase and a λ max of 254 nm. The amount of quercetin and kaempferol was found to be 31.8 and 15.01 mg/g of dried leaf extract, respectively. The presence of high levels of quercetin and kaempferol in D. viscosa leaves extract could explain its remarkable antioxidant, cytotoxic, and anti-inflammatory effects. The devolved HPTLC method can be used for routine analysis and standardization of D. viscosa crude plant material, extracts, and/or finished products using quercetin and kaempferol as appropriate markers.

In this article, we model the current and voltage across the weak link between two superconductors. This gives us a nonhomogeneous, nonlinear parametric-driven sine-Gordon equation with phase shifts. This model equation cannot be solved directly but can be approximated. For the approximations, we use two methods, and analytic perturbation method and the numerical approximation method known as the Runge–Kutta method. For the analytic method, we construct a perturbation expansion method with multiple-scale expansion. We discuss the parametric-driven in the sine-Gordon equation with phase shifts for the 0–π–0 junction. Further, we also describe the breathing modes for various order of perturbation. At the end, we compare the solutions obtained via perturbation and numerical methods of parametric-driven sine-Gordon equation with phase shifts. Finally, we concluded that the modes of the breathing decay to a constant in both cases. Also we found a good agreement between both approximate methods.

Diabetes mellitus (DM) is a metabolic complication and can pose a serious challenge to human health. DM is the main cause of many life-threatening diseases. Researchers of natural products have been continuously engaged in treating vital diseases in an economical and efficient way. In this research, we extensively used phytosteroids from Notholirion thomsonianum (Royle) Stapf for the treatment of DM. The structures of phytosteroids NtSt01 and NtSt02 were confirmed with gas chromatography–mass spectrometry (GC-MS) and nuclear magnetic resonance (NMR) analyses. Through in vitro studies including α-glucosidase, α-amylase, and DPPH assays, compound NtSt01 was found to be comparatively potent. An elevated dose of compound NtSt01 was also found to be safe in an experimental study on rats. With a dose of 1.0 mg/kg of NtSt01, the effect on blood glucose levels in rats was observed to be 519 ± 3.98, 413 ± 1.87, 325 ± 1.62, 219 ± 2.87, and 116 ± 1.33 mg/dL on the 1st, 7th, 14th, 21st, and 28th, days, respectively. The in vivo results were compared with those of glibenclamide, which reduced the blood glucose level to 107 ± 2.33 mg/dL on the 28th day. On the 28th day of NtSt01 administration, the average weights of the rats and vital organs (liver, kidney, pancreas, and heart) remained healthy, with a slight increase. The biochemical parameters of the blood, i.e., serum creatinine, blood urea, serum bilirubin, SGPT (or ALT), and serum alkaline phosphatase, of rats treated with NtSt01 remained in the normal ranges. Similarly, the serum cholesterol, triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels also remained within the standard ranges. It is obvious from our overall results that the phytosteroids (specifically NtSt01) had an efficient therapeutic effect on the blood glucose level, protection of vital organs, and blood biochemistry.

Musaddique Hussain,1 Shahzada Khurram Syed,2 Mobeen Fatima,1 Saira Shaukat,1 Malik Saadullah,3 Ali M Alqahtani,4 Taha Alqahtani,4 Talha Bin Emran,5 Ali H Alamri,6 Muhammad Qasim Barkat,7 Ximei Wu7 1Department of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, 63100, Pakistan; 2Department of Basic Medical Sciences, School of Health Sciences, University of Management and Technology Lahore, Lahore, 54000, Pakistan; 3Department of Pharmaceutical Chemistry, Government College University, Faisalabad, 38000, Pakistan; 4Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, 62529, Saudi Arabia; 5Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh; 6Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha, 62529, Saudi Arabia; 7Department of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, 310000, People’s Republic of ChinaCorrespondence: Musaddique HussainDepartment of Pharmacology, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, 63100, PakistanEmail musaddique.hussain@iub.edu.pkXimei WuDepartment of Pharmacology, School of Medicine, Zhejiang University, Hangzhou City, People’s Republic of ChinaEmail xiwu@zju.edu.cnAbstract: Acute respiratory distress syndrome (ARDS) is an overwhelming inflammatory disorder of the lung due to direct and indirect insults to the lungs. ARDS is characterized by increased vascular permeability, protein-rich edema, diffuse alveolar infiltrate, and loss of aerated lung tissue, leading to decreased lung compliance, tachypnea, and severe hypoxemia. COVID-19 is generally associated with ARDS, and it has gained prime importance since it started. The mortality rate is alarmingly high in COVID-19-related ARDS patients regardless of advances in mechanical ventilation. Several pharmacological agents, including corticosteroids, nitric oxide, neuromuscular blocker, anti-TNF, statins, and exogenous surfactant, have been studied and some are under investigation, like ketoconazole, lisofylline, N-acetylcysteine, prostaglandins, prostacyclin, and fish oil. The purpose of this review is to appraise the understanding of the pathophysiology of ARDS, biomarkers, and clinical trials of pharmacological therapies of ARDS and COVID-19-related ARDS.Keywords: acute respiratory distress syndrome, acute lung injury, COVID-19, COVID-19-related ARDS

Haytham I AlSaif,1 Mohammed M Alessa,2 Ahmed H Alajlan,2 Abdulelah I Alrshid,2 Abdulaziz F Aljarbou,2 Awadh A Alqahtani,2 Mohammad I Aljumah,2 Mansour I Alrshid,3 Aljoharah I Aleisa,4 Abdulrahman M Aloufi,5 Saad M Alsaad1 1Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2College of Medicine, King Saud University, Riyadh, Saudi Arabia; 3College of Medicine, Imam Muhammed Ibn Saud Islamic University, Riyadh, Saudi Arabia; 4College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 5College of Medicine, Almaarefa University, Riyadh, Saudi ArabiaCorrespondence: Haytham I AlSaif, Department of Family and Community Medicine, College of Medicine, King Saud University, P.O. Box 2925, Ext. 34, Riyadh, 11461, Saudi Arabia, Tel +966 114670836, Email hayalsaif@ksu.edu.saPurpose: Novel respiratory virus outbreaks are a recurring public health concern. Volunteering medical students can be a valuable asset during such times. This study investigated the willingness of medical students to volunteer during the coronavirus disease of 2019 (COVID-19) pandemic and the barriers to doing so, considering the possibility of exposure to COVID-19 and mode of contact.Patients and methods: This cross-sectional study was conducted using a self-administered online questionnaire adapted from the literature. The questionnaire comprised four parts: demographic variables, COVID-19-related variables, willingness scale, and barrier scale. The target population was medical students at four different colleges in Riyadh, Saudi Arabia.Results: A total of 802 students participated in the study. A small proportion of students (10.6%) were willing to participate in volunteering activities that could involve contact with patients with COVID-19 as compared to other settings (39.4– 43.4%). More than one-quarter of students (26.8%) had risk factors for severe COVID-19. The main barrier to volunteering was the concern of transmitting the infection to family members (76.8%). Registration to receive the COVID-19 vaccine was positively associated with more willingness to volunteer (β=0.17, p < 0.001), whereas residing in a household with an elderly person was negatively associated (β=− 0.13, p < 0.001). Female sex was positively associated with higher barrier score (β=0.12, p < 0.001).Conclusion: Medical students were more willing to volunteer in activities that did not involve direct contact with patients with COVID-19. A considerable proportion of participants had risk factors for severe illness. Sharing a household with an elderly person or child was associated with lower willingness to volunteer. Organizers of volunteering activities should offer various volunteering options considering the risk of infection; and be mindful of barriers to volunteering, especially risk factors for severe illness and eldercare and childcare responsibilities.Keywords: medical students, volunteerism, health workforce, disaster, pandemic, COVID-19

Guaianolide is a type of naturally occurring sesquiterpene lactone compounds that have attracted attention due to their diverse biological properties. In this work, a guaiane-type sesquiterpene lactone identified as deoxycynaropicrin (compound 1) was isolated and reported for the first time from the leaves of Centaurothamnus maximus with two known flavonoid derivatives namely luteolin 6-O-methyl ether (compound 2) and quercetin 3-methyl ether 5-O-glucopyranoside (compound 3). The cytotoxic activity of all the three compounds was evaluated against the THP-1 human leukemia cell lines. Moreover, flow cytometry was employed to explore the cell cycle arrest and apoptosis induction for the active compound. We found that compound 1 (deoxycynaropicrin) exerted the highest cytotoxicity while compounds 2 and 3 showed no activity. Cell cycle analysis showed that compound 1 arrested the cells’ population at the G2/M phase. Furthermore, THP-1 cells treated with compound 1 exhibited a marked increase in the apoptotic cells compared to the control. Overall, this study showed that deoxycynaropicrin induces cytotoxicity against human leukemia cell lines and provided an important insight into its potential therapeutic effects against leukemia cells.

The anticancer activity of silver nanoparticles (AgNPs) is well known to be synthesized using green-synthesized methods, although its mechanism of action is not understood fully. Moringa oleifera leaves were used as reducing and stabilizing agents to synthesize AgNPs. Green-synthesized AgNPs were characterized using ultraviolet-visible spectroscopy, dynamic light scattering, transmission electronic microscopy, scanning electronic microscopy, Fourier transform infrared, and energy-dispersive X-ray spectroscopy analyses. The synthesized nanoparticles were then characterized by their anticancer properties by performing a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. The real-time polymerase chain reaction was used to check the expression levels of the four genes (β-catenin, adenomatous polyposis coli (APC), and lipoprotein receptor-related proteins 5 and 6 (LRP5/6)). The synthesized nanoparticles were 25 nm on average and spherical in shape and aggregated form. Noteworthy cytotoxicity is how green-synthesized M. oleifera–AgNPs were observed in comparison with the M. oleifera leaf extract against a cancerous cell line. The M. oleifera–AgNPs decreased the expression of CTNNB1 and LRP6 genes, while the LRP5 gene expression increased in both cell lines. With treatment, the APC gene expression decreased in SW480 but increased in HTC116. Our results imply that AgNPs synthesized by M. oleifera extract could be an ideal strategy to combat colon cancer.

Abdullah A Alharbi,1 Khalid I Alqumaizi,2 Ibrahim Bin Hussain,3– 5 Nasser S AlHarbi,6 Abdulmalik Alqahtani,7 Wala Alzawad,8 Hussam M Suhail,9 Mohammed I Alamir,9 Mohammed A Alharbi,9 Hamad Alzamanan10 1Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, Jazan, Saudi Arabia; 2Family Medicine Department, Faculty of Medicine, AlMaarefa University, Riyadh, Saudi Arabia; 3Department of Pediatrics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 4Department of Pediatrics, College of Medicine, Al Faisal University, Riyadh, Saudi Arabia; 5Southern Business Unit, Health Holding Company Project, Healthcare Transformation, Vision Realization Office, Ministry of Health, Riyadh, Saudi Arabia; 6Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; 7Ophthalmology Department, Prince Sultan Medical Military City, Riyadh, Saudi Arabia; 8Eastern Business Unit, Health Holding Company Project, Healthcare Transformation, Vision Realization Office, Ministry of Health, Khobar, Saudi Arabia; 9Faculty of Medicine, Jazan University, Jazan City, Saudi Arabia; 10The Vision Realization Office (VRO), Ministry of Health, Riyadh, Saudi ArabiaCorrespondence: Abdullah A Alharbi, Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan City, 45142, Jazan, Saudi Arabia, Tel +966556966880, Email aaalharbi@jazanu.edu.saObjective: To assess the length of stay (LoS) variation for COVID-19 inpatients among the four regions of the Southern Business Unit (SBU).Methods: This is a comparative retrospective study of the LoS of COVID-19 inpatients in the four regions of the SBU in the KSA. Data was collected from the Ministry of Health (MoH) in all hospitals in the SBU. Participants were all patients admitted with confirmed COVID-19 between March 2020 and February 2021. Variables included region (variable of interest), demographics, comorbidities, and complications. Multilinear regression was performed to control for any factors that might have had an association with LoS.Results: The mean LoS of the total sample was 10 days and Bisha (the reference) was 7 days. Compared to Bisha, LoS in Jazan was 34% longer, in Najran 62% longer, and Aseer 40% longer. We observed that other factors also had an association with LoS, compared to Bisha, compared to the references, Saudi patients had a 15% shorter stay; admission to ICU increased LoS by 57%; patients who died during hospitalization had a 39% shorter LoS; the complications from COVID-19 of acute kidney injury and ARDS increased LoS by 22% and 48% respectively.Conclusion: After statistically controlling for confounders, this study reveals that LoS was significantly impacted by region in the SBU in the KSA. We recommend that further study be conducted to illuminate the underlying causes of this variation which may be organizational or structural to ensure high quality of care, access to care, and equity of resources throughout all regions of the SBU in accordance with the new Model of Care in Vision 2030.Keywords: COVID-19, length of stay, Southern Business Unit, Health Holding Company, KSA

High throughput screening of synthetic compounds against vital enzymes is the way forward for the determination of potent enzyme inhibitors. In-vitro high throughput library screening of 258 synthetic compounds (comp. 1-258), was performed against α-glucosidase. The active compounds out of this library were investigated for their mode of inhibition and binding affinities towards α-glucosidase through kinetics as well as molecular docking studies. Out of all the compounds selected for this study, 63 compounds were found active within the IC50 range of 3.2 μM to 50.0 μM. The most potent inhibitor of α-glucosidase out of this library was the derivative of an oxadiazole (comp. 25). It showed the IC50 value of 3.23 ± 0.8 μM. Other highly active compounds were the derivatives of ethyl-thio benzimidazolyl acetohydrazide with IC50 values of 6.1 ± 0.5 μM (comp. 228), 6.84 ± 1.3 μM (comp. 212), 7.34 ± 0.3 μM (comp. 230) and 8.93 ± 1.0 μM (comp. 210). For comparison, the standard (acarbose) showed IC50 = 378.2 ± 0.12 μM. Kinetic studies of oxadiazole (comp. 25) and ethylthio benzimidazolyl acetohydrazide (comp. 228) derivatives indicated that Vmax and Km, both change with changing concentrations of inhibitors which suggests an un-competitive mode of inhibition. Molecular docking studies of these derivatives with the active site of α-glucosidase (PDB ID:1XSK), revealed that these compounds mostly interact with acidic or basic amino acid residues through conventional hydrogen bonds along with other hydrophobic interactions. The binding energy values of compounds 25, 228, and 212 were -5.6, -8.7 and -5.4 kcal.mol-1 whereas RMSD values were 0.6, 2.0, and 1.7 Å, respectively. For comparison, the co-crystallized ligand showed a binding energy value of -6.6 kcal.mol-1 along with an RMSD value of 1.1 Å. Our study predicted several series of compounds as active inhibitors of α-glucosidase including some highly potent inhibitors.

Abdulhadi M Alqahtani,1 Saja H Almazrou,2 Randah M Alalweet,3 Ziyad S Almalki,4 Basmah F Alqahtani,5 Saleh AlGhamdi1 1Research Center, Clinical Research Department, King Fahad Medical City, Riyadh City, Saudi Arabia; 2Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 3Preventive Health - General Department of Communicable Diseases, Ministry of Health, Riyadh City, Saudi Arabia; 4Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Riyadh, Saudi Arabia; 5Pharmacist, Inpatient Pharmacy, Pharmaceutical Services Administration, King Fahad Medical City, Riyadh City, Saudi ArabiaCorrespondence: Abdulhadi M AlqahtaniResearch Center, Clinical Research Department, King Fahad Medical City, Riyadh City, Saudi ArabiaEmail ph.abdalhadi@gmail.comObjective: We aimed to evaluate the impact of the COVID-19 pandemic on the knowledge and attitudes of patients among the Saudi population toward participating in clinical trials.Methods: We conducted a descriptive, cross-sectional analysis using self-administered questionnaires for patients who attended the outpatient clinics at King Fahad Medical City and King Saud University Medical City in Riyadh, Saudi Arabia. The questionnaires included general questions about sociodemographic information, patient knowledge about clinical trials, and patient attitudes toward clinical trial participation. We used descriptive analysis to evaluate the impact of COVID-19 on patient knowledge and attitudes about clinical trials.Results: From November 2019 to October 2020, 822 responses were collected from participants in two medical cities and included in the analysis. Most of the study participants (81%) were younger than age 42 years. Our findings showed no difference between participants who participated in clinical trials before versus during the COVID-19 pandemic (P = 0.129).Conclusion: The Saudi population knows about clinical trials, but they lack knowledge about the role of the ethics committee and about informed consent. Also, most of them do not have the experience of participating in a clinical trial. Still, they have moderately positive attitudes toward clinical trials.Keywords: knowledge, attitude, clinical trials, COVID-19, Saudi Arabia

Fahmi Othman,1 Abdul Rehman Abid,1 Awad AlQahtani,1 Abdurrazzak Gehani,2 Jassim Al Suwaidi,1 Abdulrahman Arabi1 1Heart Hospital, Hamad Medical Corporation, Doha, Qatar; 2Al-Ahli Hospital, Doha, QatarCorrespondence: Fahmi OthmanHeart Hospital, Hamad Medical Corporation, PO Box 3050, Doha, QatarTel +97466580459Email fothman@hamad.qaObjective: We sought to evaluate if the non-culprit coronary artery stenosis severity is affected by primary percutaneous coronary intervention (PPCI) compared with non-PPCI settings.Methods: Review of all the PPCI angiograms was performed at our catheterization laboratory between 15th October 2013 and 15th October 2014. All patients with severe multi-vessel coronary artery disease (MV CAD) who underwent second angiograms (either during the same admission or after discharge) were analyzed. Non-culprit lesions in the PPCI and non-PPCI angiograms were compared. Two investigators blinded to the procedure dates analyzed the severity of the lesions using validated quantitative coronary angiography software (QCA).Results: Among 777 patients who underwent PPCI, 458 had multi-vessel disease. Additional angiography to treat non-culprit lesions was performed in 104, of these, 69 patients had a combined total of 74 lesions suitable for QCA analysis. The second angiogram was performed during the same admission (mean 4± 2.7 days) and after discharge (mean 115± 84 days) for 48 and 21 patients, respectively. Compared to PPCI angiograms, the non-PPCI angiograms showed a statistically significant reduction in the percentage of stenosis (71.6± 14.4% vs 64.5± 14.4%, p≤ 0.001), and an increase in minimal luminal diameter (0.82± 0.45 mm vs 1.00± 0.44 mm, p≤ 0.001) of non-culprit lesion. However, no significant difference was observed in the reference diameter (2.89± 0.69 mm vs 2.83± 0.64 mm, p=0.1) of the non-culprit lesion in both angiograms. Furthermore, these differences in the lesion parameters remain constant whether the second angiogram was performed during the same admission or performed after discharge (73.3± 14% and 66.2± 12.9% vs 68.4± 15% and 61.2± 16%, p=0.1).Conclusion: The severity of non-culprit lesion is exaggerated in the PPCI setting. The non-culprit lesion exaggeration remains constant whether the second angiogram was performed early within a few days or later after several weeks.Keywords: acute myocardial infarction, coronary angiogram, minimal lumen diameter, non-culprit lesion, primary percutaneous coronary intervention

Adel Alfatease,1 Ali M Alqahtani,2 Khalid Orayj,3 Sultan M Alshahrani3 1Pharmaceutics Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Pharmacology Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 3Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi ArabiaCorrespondence: Sultan M AlshahraniClinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, 61441, Saudi ArabiaTel +966 508747473Email shahrani@kku.edu.saIntroduction: Social media platforms are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination.Purpose: The objective of this study is to understand the influence of social media on the attitudes and willingness of the general public of the Aseer region of Saudi Arabia to receive COVID-19 vaccination.Materials and Methods: A cross-sectional self-administrated online survey was conducted in Saudi Arabia Aseer region, where 613 persons willingly took part in the survey in April and May 2021. Residents of Aseer in Saudi Arabia, who are over the age of 18 (eligible for COVID-19 vaccination) and willing to participate in the survey, were included in the study.Results: Overall, 74.6% agreed that the COVID-19 vaccine was misrepresented via social media. However, 37% of those respondents strongly agreed that social media had increased their willingness to get the COVID-19 vaccine. In addition, employees reported (21.8%) or strongly agreed (28%) that the quantity and quality of information on social media has a detrimental impact on their psychological well-being. Additionally, participants also agreed (21.8%) or strongly agreed (28%) that social media had a negative effect on their psychological condition.Conclusion: The study provides that there was a high degree of awareness indicated among Aseer population regarding misleading information about COVID-19 vaccination via social media. Thus, social media that can share up-to-date scientific information about vaccination must be utilized optimally by the government to assist people in making decisions about accepting vaccinations.Keywords: social media, COVID-19, vaccination, survey, Saudi Arabia

Esraa Altawil,1,&ast; Hadeel Alkofide,2,&ast; Husam Alamri,3 Noura Alhassan,4 Hamad Alsubaie,3 Awadh Alqahtani,3 Omar Alobaid4 1Pharmacy Department, Clinical Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia; 2Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 3Department of Surgery, King Saud University, College of Medicine, Riyadh, Saudi Arabia; 4Department of Surgery, Colorectal Research Chair, King Saud University, College of Medicine, Riyadh, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Omar AlobaidDepartment of Surgery, Colorectal Research Chair, College of Medicine, King Saud University, P.O. Box 7805, Riyadh, 11472, Saudi ArabiaTel +966 558670000Email oalobaid@ksu.edu.saIntroduction: Bariatric surgery provides an effective option for the management of morbid obesity. Several studies have investigated the association between bariatric surgery and secondary hyperparathyroidism (SHPT). This study aims to compare the levels of blood biomarkers, specifically, calcium (Ca), vitamin D, and phosphate (PO4), and their association with parathyroid hormone (PTH) levels pre- and post-bariatric surgery. In addition, it aims to assess the prevalence of hyperparathyroidism post-bariatric surgery in a tertiary care hospital in Saudi Arabia.Material and Methods: A prospective cohort study was conducted at a large tertiary care hospital between May 2017 and April 2019. The study included adult obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Patients were excluded if they were known to have any comorbidities, receiving vitamin supplements, and those who had undergone bariatric procedures previously. Routine blood tests, including PTH, vitamin D, Ca, and PO4, were collected at baseline, and post-surgery.Results: A total of 143 patients who underwent LSG were included in the study. Hyperparathyroidism was observed in 15.4% of patients at baseline and in 36.4% of patients’ post-surgery (p < 0.001). Low vitamin D levels, which were highly prevalent before surgery, decreased sustainably (66.4% pre-operative and 28% at follow-up after surgery, P=0.032). Baseline hypocalcemia was observed in 20.3% of patients compared to 8.4% post-surgery (P=0.546). Hypophosphatemia was present in 60.8% of subjects at baseline, while the percentage dropped to 21.7% post-surgery. There was a significant association between PO4 and PTH levels at baseline. Post-operatively, there was a significant correlation between PTH and both vitamin D and calcium levels.Conclusion: Our study showed that the higher levels of PTH post LSG can be related to vitamin D deficiency and lower calcium levels, despite patients following the provided recommendations for supplementation. This study also emphasizes the importance of routine testing for hyperparathyroidism both before and after bariatric surgery.Keywords: bariatric surgery, morbid obesity, hyperparathyroidism, calcium, vitamin D

Different phytochemicals from various plant species exhibit promising medicinal properties against cancer. Juniperus phoenicea is a plant species that has been found to present medicinal properties. Herein, crude extract and fractions of J. phoenicea were examined to determine its anticancer properties against several cancer cells. The active fraction was chosen to assess its activity on cell cycle progression and apoptosis induction by annexin and propidium iodide (PI) biomarkers. Further, phytochemical screening for possible contents of active fraction using gas chromatography–mass spectrometry (GC-MS) analysis was conducted. It was demonstrated that cell proliferation was suppressed, and the MCF-7 cell line was the most sensitive to J. phoenicea chloroform fraction (JPCF), with the IC50 values of 24.5 μg/mL. The anti-proliferation activity of JPCF in MCF-7 cells was linked to the aggregation of cells in the G1 phase, increases in early and late apoptosis as well as necrotic cell death. Contents analysis of JPCF using GC-MS analysis identified 3-methyl-5-(2′,6′,6′-trimethylcyclohex-1′-enyl)-1-penten-3-ol (16.5%), methyl 8-oxooctanoate (15.61%), cubenol (13.48%), and 7-oxabicyclo [2.2.1] heptane (12.14%) as major constituents. Our present study provides clear evidence that J. phoenicea can inhibit cell proliferation, trigger cell cycle arrest, and induce apoptosis in tested cancer cells.

Fatema S Shaikh,1 Nahier Aldhafferi,1 Areej Buker,1 Abdullah Alqahtani,1 Subhodeep Dey,2 Saema Abdulhamid,1 Dalal Ali Mahaii AlBuhairi,1 Raha Saud Abdulaziz Alkabour,1 Waad Sami O Atiyah,1 Sara Bachar Chrouf,1 Abdussalam Alshehri,3 Sunday Olusanya Olatunji,1 Abdullah M Almuhaideb,1 Mohammed S Alshahrani,4 Yousof AlMunsour,1 Vahitha B Abdul-Salam5 1College of Computer Science and Information Technology, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia; 2Indian Institute of Management – Calcutta, Kolkata, India; 3Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia; 4College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia; 5Centre for Cardiovascular Medicine and Device Innovation, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UKCorrespondence: Fatema S Shaikh Tel +966-5591660024Email fsshaikh@iau.edu.saPurpose: The first novel coronavirus disease-19 (COVID-19) case in the Kingdom of Saudi Arabia (KSA) was reported in Qatif in March 2020 with continual increase in infection and mortality rates since then. In this study, we aim to determine risk factors which effect severity and mortality rates in a cohort of hospitalized COVID-19 patients in KSA.Method: We reviewed medical records of hospitalized patients with confirmed COVID-19 positive results via reverse-transcriptase-polymerase-chain-reaction (RT-PCR) tests at Prince Mohammed Bin Abdulaziz Hospital, Riyadh between May and August 2020. Data were obtained for patient’s demography, body mass index (BMI), and comorbidities. Additional data on patients that required intensive care unit (ICU) admission and clinical outcomes were recorded and analyzed with Python Pandas.Results: A total of 565 COVID-19 positive patients were inducted in the study out of which, 63 (11.1%) patients died while 101 (17.9%) patients required ICU admission. Disease incidences were significantly higher in males and non-Saudi nationals. Patients with cardiovascular, respiratory, and renal diseases displayed significantly higher association with ICU admissions (p< 0.001) while mortality rates were significantly higher in COVID-19 patients with cardiovascular, respiratory, renal and neurological diseases. Univariate cox proportional hazards regression model showed that COVID-19 positive patients requiring ICU admission [Hazard’s ratio, HR=4.2 95% confidence interval, CI 2.5– 7.2); p< 0.001] with preexisting cardiovascular [HR=4.1 (CI 2.5– 6.7); p< 0.001] or respiratory [HR=4.0 (CI 2.0– 8.1); p=0.010] diseases were at significantly higher risk for mortality among the positive patients. There were no significant differences in mortality rates or ICU admissions among males and females, and across different age groups, BMIs and nationalities. Hospitalized patients with cardiovascular comorbidity had the highest risk of death (HR=2.9, CI 1.7– 5.0; p=0.020).Conclusion: Independent risk factors for critical outcomes among COVID-19 in KSA include cardiovascular, respiratory and renal comorbidities.Keywords: COVID-19, SARS-CoV-2, mortality rate, comorbidities, risk factors, KSA

Testing is an effective method to determine learning outcomes for knowledge and skills learning domains. The aim of this study was to examine the differences in test achievements among 50 Saudi female English major students at the College of Languages at Princess Nourah University in Riyadh. The tests were administered using two different methods: paper-based and Blackboard-based (online). Additionally, the study explored the impact of these two test methods on students' achievement in terms of course learning outcomes. The results of the study indicated that there was no significant difference between the two test methods in terms of overall test scores. However, it was found that the Blackboard-based test resulted in slightly higher scores for knowledge domain outcomes, while the paper-based test showed higher scores for skills domain outcomes. The results obtained in this study suggest that both paper-based and Blackboard-based test methods can be equally effective at assessing the general achievement of students. However, the choice of test method may have a slight impact on the specific learning outcomes being assessed, with Blackboard-based tests favouring knowledge domain outcomes and paper-based tests favouring skills domain outcomes. Furthermore, when using Blackboard-based tests, time pressure should be taken into consideration, as it is observed to significantly influence students' performance in both learning domains.

This study examines the factors affecting the intention to use and actual use of YouTube in improving English-speaking skills in Indonesia. To meet the aims, we extended the theory of technology acceptance model (TAM); two external factors, subjective norms, and perceived enjoyment, to support the TAM variables (perceived ease of use, perceived usefulness, attitude, intention to use, and actual use). Data were collected through a survey with 526 measurable responses from Indonesian preservice English teachers in three Indonesian universities. The data were analyzed through partial least square structural equation modeling (PLS-SEM), measurement, and structural model. The findings informed that all hypothesized relationships were accepted and confirmed. The strongest relationship emerged between intention to use and actual use. Meanwhile, the weakest correlation was between subjective norms and perceived ease of use. The study facilitates recommendations for future researchers, language educators, and all related parties.