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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

Raghad M Ali,1 Abdulkarim A Aljabri,1 Nahla H Hariri,2 Ghadi S Bokhari,1 Shahad A Alturkistani,1 Nidaa A Albishri,1 Hamza A Alzahrani,1 Shuruq A Alghamdi,3 Renad T Alhazmi,1 Enas H Alfalogy2,4 1College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 2Community Medicine and Pilgrims Healthcare Department, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 3Directorate of Health Affairs, Eradah Complex for Mental Health, Jeddah, Saudi Arabia; 4Family Medicine Department, Faculty of Medicine, Suez -Canal University, Ismalia, EgyptCorrespondence: Nahla H Hariri, Community Medicine and Pilgrims Healthcare Department, College of Medicine, Umm Al-Qura University, Makkah, 21955, Saudi Arabia, Email nhhariri@uqu.edu.saPurpose: This study aims to assess the knowledge, attitudes, and practices of emergency physicians (EPs) related to psychiatric emergencies (PEs) in Makkah’s general hospitals.Sample and Methods: This study was an observational cross-sectional study using an online survey distributed to 138 EPs in the emergency departments (EDs) of six public hospitals in Makkah City, Saudi Arabia, between March 15 and May 1, 2023. A convenience sample was used for data collection. The questionnaire was developed after related surveys in the literature were reviewed.Results: 59.9% of the physicians were aged 20– 30 years. Most (68.8%) worked in hospitals that had psychiatric facilities. Regarding knowledge, only 30% of the emergency doctors were considered knowledgeable: the majority could identify PEs (79.7%), perform mental status examinations (71.0%), distinguish physical and mental symptoms (66.7%), and communicate with psychiatric patients (58.0%). However, only 52.9% could initiate management plans by prescribing psychiatric medication to patients. In relation to attitude, most physicians disagreed with the idea that healthcare practitioners do not need to advocate for psychiatric patients (67.4%), but many (62.3%) assumed that they do not have the responsibility to manage psychiatric patients, and they felt that conducting psychiatric evaluations in public hospitals is challenging because of the busy environment there. As regards practice, mentally ill patients (60.9%) were managed or referred by practices, and 56.5% of the EPs advised these patients upon discharge.Conclusion: The study showed that EPs have positive attitudes toward psychiatric patients, but their knowledge varied based on age, occupation levels, and years of experience. There were significant knowledge gaps, particularly regarding effective communication with psychiatric patients. Additionally, many EPs manage psychiatric patients without being aware of the psychiatric resources in their hospital. Improving medical school curricula and postgraduate training can enhance care. However, more research in this field is needed.Keywords: emergency departments, psychiatric patients, public hospitals, mental status examination

Hassan A Alzahrani Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Hassan A Alzahrani, Email hahassan@kku.edu.saObjective: This study aimed to assess the presence and type of malignancy in patients who underwent thyroid surgery for solitary thyroid nodules.Methods: A retrospective review was performed of the case notes of all adult patients with solitary thyroid nodules who underwent thyroid surgery from 1 January 2019 to 31 October 2022. All patients had solitary thyroid nodules identified by ultrasonography. The electronic records of our pathology department were used to determine the pathological diagnosis.Results: Forty-two patients with solitary thyroid nodules underwent thyroid surgery. The mean age at presentation was 39.1 ± 12.6 years, and 76.2% of patients were female. The malignancy rate was 31%. Further histopathological analysis found that malignant solitary thyroid nodules were mostly papillary carcinoma.Conclusion: This study indicates that solitary thyroid nodules should be evaluated thoroughly and treated with a high index of suspicion because they have a high chance (31%) of being malignant.Keywords: thyroid, endocrine, surgery, solitary thyroid nodule, malignancy

Eman R Abdelbary,1 Ashraf M Elsaghier,2 Rehab M Abd El-Baky,3,4 Nancy GFM Waly,3 Mohammed Ramadan,1 Fatma S Abd- Elsamea,5 Mohamed E Ali,1 Hayat A Alzahrani,6 Mohammed Salah7 1Microbiology and Immunology Department, Faculty of Pharmacy, Al-Azhar University-Assiut Branch, Assiut, 11651, Egypt; 2Gastroenterology and Hepatology Unit, University Children Hospital, Faculty of Medicine, Assiut University, Assiut, 11651, Egypt; 3Microbiology and Immunology Department, Faculty of Pharmacy, Minia University, Minia, 61519, Egypt; 4Microbiology and Immunology Department, Faculty of Pharmacy, Deraya University, Minia, 11566, Egypt; 5Medical Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut, 11651, Egypt; 6Department of Medical Laboratory Technology, Faculty of Applied Medical Science, Northern Border University, Arar, 91431, Saudi Arabia; 7Microbiology and Immunology Department, Faculty of Pharmacy, Port Said University, Port Said City, 42526, EgyptCorrespondence: Rehab M Abd El-Baky, Email rehab.mahmoud@mu.edu.egIntroduction: New Delhi metallo-β-lactamase (NDM)-producing K. pneumoniae poses a high risk, especially among Egyptian pediatric patients who consume carbapenems antibiotics very widely and without adequate diagnostic sources. In addition, presence of efflux pump genes such as OqxAB increases resistance against many groups of antimicrobials which exacerbates the problem faced for human health. This study aimed to determine NDM variants among K. pneumoniae strains isolated from pediatric patients in Egypt, analyze the presence of OqxAB genes, and molecular characterization of blaNDM-5-positive K. pneumoniae.Methods: Fifty-six K. pneumoniae isolates were recovered from pediatric patients, and tested for carbapenemase by modified carbapenem inactivation methods (mCIM) test. Minimum inhibitory concentrations of meropenem and colistin were determined by meropenem E-test strips and broth microdilution, respectively. PCR was used for the detection of the resistant genes (ESBL gene (blaCTX-M), carbapenemase genes (blaNDM, blaKPC) colistin resistant (mcr1, mcr2)) and genes for efflux pump (oqxA and oqxB). BlaNDM was sequenced. The effect of efflux pump in NDM-5-producing isolates was assessed by measuring MIC of ciprofloxacin and meropenem before and after exposure to the carbonyl cyanide 3-chlorophenylhydrazone (CCCP). The horizontal gene transfer ability of blaNDM-5 was determined using liquid mating assay and PCR-based replicon typing (PBRT) was done to determine the major plasmid incompatibility group.Results: Twenty-nine isolates were positive for blaNDM-1, nine isolates were positive for blaNDM-5, and 15 isolates were positive for blaKPC. There is a significant increase of meropenem MIC of NDM-5-positive isolates compared with NDM-1-positive isolates. In addition, 38 isolates were positive for CTX-M, and 15 isolates were positive for mcr1. Both OqxA and OqxB were detected in 26 isolates and 13 isolates were positive for OqxA while 11 isolates were positive for OqxB only. All NDM-5-producing isolates except one isolate could transfer their plasmids by conjugation to their corresponding transconjugants (E. coli J53). Plasmid replicon typing showed that FII was predominant in NDM-5-producing K. pneumoniae. Similar strains were found between the three isolates and similarity was also detected between the two isolates.Conclusion: The highly resistant K. pneumoniae producing blaNDM-5 type was firstly isolated from pediatric patients. The association of efflux pump genes such as OqxAB is involved in resistance to ciprofloxacin. This highlighted the severity risk of blaNDM-5-positive K. pneumonia as it could transfer blaNDM-5 to other bacteria and has more resistance against carbapenems. This underlines the importance of continuous monitoring of infection control guidelines, and the urgent need for a national antimicrobial stewardship plan in Egyptian hospitals.Keywords: blaNDM-5, OqxAB, carbapenem resistant K. pneumoniae, efflux pumps

Hassan A Alzahrani,1 Mohammad Tauheed Ahmad,2 Ziyad S Alasmari,3 Fares A Aljarallah,3 Lubna M Hafiz,3 Basim A Almasoudi,3 Ahmad A Alibrahim,3 Walid M Abd El Maksoud,1 Mohammed A Bawahab,1 Mohammed A Alsaleem4 1Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia; 2Department of Medical Education, College of Medicine, King Khalid University, Abha, Saudi Arabia; 3Medical Student, College of Medicine, King Khalid University, Abha, Saudi Arabia; 4Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Hassan A Alzahrani, Department of Surgery, College of Medicine, King Khalid University, P.O. Box 641, Abha, Saudi Arabia, Email hahassan@kku.edu.saBackground: Saudi Arabian population has amongst the highest prevalence of obesity globally. Apart from nutritional measures, physical activity is considered a major modifiable risk factor for the prevention of obesity and its consequences. An insight into the physical activity and awareness parameters of healthcare professionals and those in the making can provide an insight into how prepared we are to deal with the epidemic of non-communicable diseases. The aim of this study is to find out about the degree of physical activity undertaken by the medical students, faculty and staff at the College of Medicine, King Khalid University, as well as their awareness regarding physical activity guidelines.Methods: This study surveyed 300 adult participants - medical students, faculty and staff - in the College of Medicine, King Khalid University. An international validated questionnaire was used to assess the physical activity profile of participants as well as BMI parameters. Moreover, awareness and knowledge of the recommended physical activity guidelines for adults were also assessed.Results: The study participants comprised around 83% students, 9% faculty members, and 7% staff members. Around 55% of the participants were male, while the rest were female. More than 65% of participants across all categories reported low levels of physical activity, with only about 4.5% of participants across various age groups reporting high levels of physical activity. There was no significant difference by gender across the group (P value = 0.227). Only 17% of the study participants were knowledgeable of the recommended physical activity guidelines for adults.Conclusion: We found a low level of physical activity as well as inadequate awareness about the physical activity guidelines amongst our study participants. This study reiterates the urgent need for well-researched and well-funded health promoting interventions to promote physical activity, especially in the context of health professions’ education.Keywords: obesity, overweight, physical activity, physical activity guidelines

Hassan A Alzahrani Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Hassan A Alzahrani, Email hahassan@kku.edu.saBackground: Mild-to-moderate postoperative pain is common after surgical procedures of the thyroid. Opioid analgesics have been commonly prescribed in such cases, but their use has been debated owing to concerns regarding the addictive nature of opioids. Recently, experts from the Endocrine Surgery Section of the American Head and Neck Society released a consensus document to limit the use of opioids as the first-line pain control medication after head and neck or endocrine procedures. However, differences in pain management prescriptions have been noted in many settings. This study aims to assess the post-thyroid surgery pain control medication prescription practices of head and neck and endocrine surgeons.Methods: This study retrospectively reviewed the charts of 105 adult patients who underwent thyroid surgery (total thyroidectomy, thyroid lobectomy, or subtotal thyroidectomy) by head and neck or endocrine surgeons. The type of prescribed pain medication at hospital discharge postoperatively was then retrieved from each patient’s discharge medication list. Descriptive statistics mean, standard deviations, frequencies, and percentages were computed, while the Chi-square test was applied to measure the significant differences among variables at a 5.00% significant level.Results: An outpatient oral opioid, in the form combining paracetamol and codeine, was prescribed for 62 (59%) patients, whereas 43 (41%) were discharged on paracetamol only.Conclusion: The use of opioids is the practice pattern for pain management among some head and neck or endocrine surgeons despite emerging evidence that supports the use of non-opioid and other alternative analgesic strategies in outpatient thyroid and parathyroid surgery. Further research and quality improvement interventions should be geared towards leading all health professionals to appropriate prescription practices to improve patient safety and reduce unnecessary opioid prescriptions.Keywords: thyroid, endocrine, surgery, postoperative, pain medication, opioid, opioid addiction

Hasan A Alzahrani,1 Owiss H Alzahrani21Department of Surgery, 2Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaObjectives: To identify medical students' perceptions of their learning strategies including, learning habits, resources, and preferred teaching methods, in the Department of Surgery (DOS) of the King Abdulaziz University-Faculty of Medicine (KAU-FoM), in Jeddah, Saudi Arabia.Methods: A cross-sectional descriptive study which was designed to identify students' perceptions of their learning in the DOS of the KAU-FoM. A questionnaire was administered to a random group of 549 medical students, to explore student perceptions of their learning strategies including methods of learning and learning resources.Results: The majority believed that clinical session attendance is always important compared with lectures (88.9% vs 21.9%). Nevertheless, clinical sessions were selected as the third source of learning after learning from assigned textbooks and previous examination model answers. The majority (74.1%) believed that self-instruction at home is the preferred method of learning.Conclusion: Student perspectives should be taken into consideration prior to any future reforms of curriculum. Reforms should adopt a “think globally; act locally” educational strategy based on learner needs.Keywords: education, medical, learning, surgery, developing countries

Soil erosion is the major environmental risk that causes topsoil loss, which decreases fertility in agricultural land. Spatial estimation of soil erosion is essential for conserving land resources and for developing control plans. This study evaluated soil erosion in 17 sub-basins of the Wadi Hanifa catchment using the Gavrilović model. The soil erosion rate is categorized into three classes based on the annual volume of rainfall and runoff. About 21% of the drainage area of Wadi Hanifa is affected by erosion severity, and 33% of the area is affected by severe erosion. The correlation obtained between the annual soil erosion and annual volumes of rainfall and runoff is significant. It is concluded from the results that the drainage area of the north-western part suffers from a high soil erosion risk. The NRCS-CN and erosion predict that the Gavrilović model can be applied for estimating and analyzing the spatial distribution of soil erosion over more drainage watersheds in Saudi Arabia. Now, the GIS techniques are one of the best tools for developing the conservation and management planning processes of soil resources.

Estimating the density interface depth is an important task when interpreting gravity data. A range of techniques can be applied for this. Here we compare the effectiveness of the wavenumber and spatial domain techniques for inverting gravity data with respect to basement reliefs. These techniques were tested with two synthetic gravity models, and then applied to a real case: the gravity data of the Magura basin (East Slovakian Outer Carpathian). The findings show that the spatial domain technique can precisely estimate the structures, but the computation speed is slow, while the wavenumber domain technique can perform faster computations with less precision.

In this study, we investigated the stability and reactivation of preexisting Tonghua landslide deposits in China, including the adjacent stable slope. We used an integrated approach, combining a multichannel analysis of surface waves (MASW) and electrical resistivity tomography (ERT). We used ERT to determine groundwater seepage paths, weathering conditions, water content, and the depth to bedrock. High-resolution two-dimensional (2D) shear-wave velocity MASW images, on the other hand, played an essential role in detecting both horizontal and vertical compositions, disjointedness, and sliding surfaces related to lithological borders. Based on seismic models, we considered four geological layers encountered in the stable slope, including fractured (gravel) and weathered (phyllite) materials, as a sliding mass. We combined the 2D resistivity profiles obtained to create pseudo-three-dimensional ERT images to estimate water-saturated and unsaturated masses. From the tomography results, we identified different preexisting deposits, including buried arable clay deposits, old accumulated earthflow deposits, a water accumulation zone, and a fissure runoff. Based on the resistivity results, the bottom of the earthflow deposits is susceptible to water, and oversaturation can reactivate the earthflow.

The physical, geochemical, and clay mineralogical properties are location dependent and influence landslide, yet this relationship is understudied in the Cameron Highlands. Therefore, this study demonstrates the effect of the selected physical–geochemical properties and clay mineralogy on landslide susceptibility (LS) in the Cameron Highlands, Malaysia. Seven soil samples were taken from non-landslide-affected slopes (NAS) and 13 from landslide-affected slopes (LAS), making a total of 20 samples that were analyzed. The degree of the LAS and NAS ranges from 42–80° and 30–70°, respectively. The NAS soils were characterized by lower sand, higher clay, higher organic matter content (OMC), and higher cation exchange capacity (CEC). Soils with high sand tend to have larger free pores and weak bonds, making them more vulnerable to landslides. The electrostatic charges on the clay’s surface bind the solution ions, increasing cohesion between soil particles. Also, high CEC in soils improves their stability through the binding effect resulting from the attraction between solution ions via the electrostatic surface charges of the clay in the soil. The clay mineralogy revealed the abundance of kaolinite and illite, indicating the last stage of weathering associated with the weathering of primary minerals forming the bedrock. In this study, it was demonstrated that high sand, low clay, low OMC, low CEC, and clay mineralogy of the soil were associated with slope failure in the study area.

Abstract Background Bullying and sexual harassment of medical students by their teachers appears to be widespread phenomenon. However, nothing is published about its prevalence in conservative countries such as Saudi Arabia. This survey aims to ascertain the extent of these mistreatments among students in a Saudi medical school. Findings A cross-sectional questionnaire survey was conducted on a group of 542 clinical years’ medical students in a Saudi medical school to explore students' perceptions of their educational environment including exposure to different kinds of bullying. Bullying was defined as “a “persistent behaviour against a medical student that is intimidating, degrading, offensive or malicious and undermines the confidence and self- esteem of the recipient”. Results revealed that more than one quarter (28.0%) of the surveyed students reported exposure to some sort of bullying during their clinical. Ninety percent of the reported insults were verbal, 6% sexual and 4% physical. Males were more exposed but difference was not statistically significant. Conclusions Bullying among Saudi medical students is an existing problem. A policy against bullying and harassment should be adopted in all of medical colleges to monitor this phenomenon and support students who have been bullied.

Abstract Background There is little published on current Saudi diabetic patients' practices when they are exposed to foot disorders such as open wound, ulcer, and skin cracks. These factors are usually influenced by local culture and communities beliefs. The aim of the current study was to identify the pattern of patients' use of CAM products in dealing with diabetic foot disorders topically in a group of diabetic patients. Findings A Cross-sectional descriptive study of a representative cohort of diabetic patients living in Jeddah, Saudi Arabia was designed. A pre-designed questionnaire to identify local diabetics' practices in dealing topically with foot disorders including open wound, chronic ulcer, and skin cracks was designed. Questionnaire was administered by a group of trained nutrition female students to diabetics face to face living in their neighborhood. A total of 1634 Saudi diabetics were interviewed. Foot disorders occurred in approximately two thirds of the respondents 1006 (61.6%). Out of the 1006 patients who had foot disorders, 653 reported trying some sort of treatment as 307 patients (47.1%) used conventional topical medical treatment alone, 142 (21.7%) used CAM products alone, and 204 (31.2%) used both treatments. The most commonly used CAM product by the patients was Honey (56.6%) followed by Commiphora Molmol (Myrrh) in (37.4%) and Nigellia Sativa (Black seed) in (35.1%). The least to be used was Lawsonia inermis (Henna) in (12.1%). Ten common natural preparations used topically to treat diabetic foot disorders were also identified. Conclusions The use of CAM products in topical treatment of diabetic foot disorders is fairly common among Saudi diabetic patients. Honey headed the list as a solo topical preparation or in combination with other herbs namely black seeds and myrrh. The efficacy of the most common products needs further research.

Since 2020, many compounds have been investigated for their potential use in the treatment of SARS-CoV-2 infection. Among these agents, a huge number of natural products and FDA-approved drugs have been evaluated as potential therapeutics for SARS-CoV-2 using virtual screening and docking studies. However, the identification of the molecular targets involved in viral replication led to the development of rationally designed anti-SARS-CoV-2 agents. Among these targets, the main protease (Mpro) is one of the key enzymes needed in the replication of the virus. The data gleaned from the crystal structures of SARS-CoV-2 Mpro complexes with small-molecule covalent inhibitors has been used in the design and discovery of many highly potent and broad-spectrum Mpro inhibitors. The current review focuses mainly on the covalent type of SARS-CoV-2 Mpro inhibitors. The design, chemistry, and classification of these inhibitors were also in focus. The biological activity of these inhibitors, including their inhibitory activities against Mpro, their antiviral activities, and the SAR studies, were discussed. The review also describes the potential mechanism of the interaction between these inhibitors and the catalytic Cys145 residue in Mpro. Moreover, the binding modes and key binding interactions of these covalent inhibitors were also illustrated. The covalent inhibitors discussed in this review were of diverse chemical nature and origin. Their antiviral activity was mediated mainly by the inhibition of SARS-CoV-2 Mpro, with IC 50 values in the micromolar to the nanomolar range. Many of these inhibitors exhibited broad-spectrum inhibitory activity against the Mpro enzymes of other coronaviruses (SARS-CoV-1 and MERS-CoV). The dual inhibition of the Mpro and PLpro enzymes of SARS-CoV-2 could also provide higher therapeutic benefits than Mpro inhibition. Despite the approval of nirmatrelvir by the FDA, many mutations in the Mpro enzyme of SARS-CoV-2 have been reported. Although some of these mutations did not affect the potency of nirmatrelvir, there is an urgent need to develop a second generation of Mpro inhibitors. We hope that the data summarized in this review could help researchers in the design of a new potent generation of SARS-CoV-2 Mpro inhibitors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Abdominoplasty, an emerging surgical procedure worldwide, associated with complications, as seroma, infection, and hematoma. This systematic review and meta-analysis compare the outcomes of abdominoplasty procedures performed using a scalpel versus a diathermocoagulation device (diathermy monopolar electrocautery), aiming to find a safer approach with fewer complications., Methods: We conducted a systematic search in November 2023 using PubMed, Ovid Medline, and Ovid Chocrane databases. The methodological index for nonrandomized studies and the Revised Cochrane Risk of Bias assessment tools were used to assess risk of bias for observational studies and randomized controlled trials, respectively. The data were analyzed using RevMan software., Results: Six articles (1135 patients) were included, 521 patients were operated using a scalpel and 614 using electrocautery. Our analysis suggests that both seroma and drain output were seen more among the electrocautery group, with an odds ratio (OR) of 0.62 (95% CI [0.39, 0.97], p = 0.04) and - 103.63 (95% CI [- 205.67, - 1.59], p = 0.05), respectively. It is important to note the high heterogeneity seen among the studies discussing the total drain output. Additionally, we did not find any statistical significance between both techniques in terms of the rate of hematoma, wound infection, operation time, and hospital stay length., Conclusion: When comparing the use of scalpel and electrocautery dissection in abdominoplasty, higher rates of seroma and total drain output are significantly associated with electrocautery dissection., Level of Evidence Ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Hepatocellular carcinoma (HCC) is a common critical type of hepatic cancer worldwide. Recent guidelines have considered ablative therapeutic approaches as the primary option for managing early-stage surgically untreatable HCC. Among these therapies, radiofrequency ablation (RFA) and microwave ablation (MWA) have attained a significant role due to their efficacy and theoretical advantages. This review aims to compare and analyze the efficacy and safety of two common modalities, i.e., MWA and RFA, in the management of HCC. The literature search included PubMed, Cochrane Central Register of Controlled Trials, Medline, and Ovid for articles published until 2024. The outcomes included the local tumor progression (LTP), complete ablation (CA), the overall survival (OS) rate, or major complications. A meta-analysis was performed using Review Manager 5.3. The systematic review included six randomized controlled trials, including 826 patients. The findings revealed that MWA resulted in lower LTP and higher CA rates compared to RFA. However, the effect of complications was higher in the MWA therapy group. Despite that, the differences between all parameters were not significant. Statistical significance was not evident in the OS rates between the two modalities. Three studies found comparable survival rates between the two modalities, while one study reported similar local tumor recurrence-free survival rates between the two approaches. Both techniques appear to be effective and safe for the management of liver tumors, providing clinicians with valuable options for personalized patient care. Further high-quality research is needed to confirm these findings and guide clinical decision-making., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shaqran et al.)

A hypertensive crisis is defined as a sudden and significant rise in blood pressure. The blood pressure reading is 180/120 mmHg or higher. A hypertensive crisis is a medical emergency. It can lead to a heart attack, stroke, or other life-threatening medical problems. Investigating the management of the hypertensive crisis was the goal of this study. English-language articles were collected from 2010 to 2024 demonstrating the management of the hypertensive crisis. Overall, there were 15 articles. Surveys and analyses of national databases were the most widely used methods (n=15). The scientific studies documented (1) all investigative studies or reports that included a hypertensive crisis diagnosis, (2) data integrity and reproducibility, and (3) management studies. Other studies show that acute severe hypertension in the hospital is associated with high rates of mortality and morbidity, particularly with new or worsening end-organ damage. The problem is linked to poor medical adherence, but alarmingly low follow-up rates are likely to contribute to a high recurrence rate. The treatment of acute severe hypertension varies according to the hospital unit (medical ward or intensive care unit), medication, and blood pressure targets or thresholds. Because of a lack of evidence-based guidance, arbitrary blood pressure control targets are used, or blood pressure targets are crudely extrapolated from guidelines intended primarily for outpatient management. Patients with acute aortic dissection need to be administered intravenous esmolol within 5 to 10 minutes in order to lower their blood pressure right away. The goal is to maintain a systolic reading of less than 120 mm Hg. Vasodilators such as nitroglycerin or nitroprusside may be administered if the blood pressure persists following beta blocking. Intravenous administration of clevidipine, nicardipine, or phentolamine is required; the initial dose is 5 mg, with subsequent doses given every 10 minutes as necessary to achieve the desired reduction in blood pressure., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khan et al.)

Saudi Arabia guarantees citizens the right to receive medical care and treatment during emergencies or sickness and aging. However, with the consistent increase in expenditure and inability to provide access, the transformation was an unavoidable action. Therefore, this paper aims to address the potential and risks behind the National Transformation Program (NTP) in Saudi Arabia through the lens of the Value Transformation Framework. Multiple research databases (PubMed, Web of Science, UpToDate, Google Scholar, and Summon) were searched between 2016 and 2024. Relevant articles were selected by scanning the title and abstract, yielding 34 references after the screening, exclusion, and inclusion criteria were met. Citation software was used to identify additional sources as analysis proceeded, in accordance with the hermeneutic approach in mapping and classification. The most cited concerns were the sustainability and workforce of the healthcare system. In terms of care delivery, the literature was extensive. In contrast, insufficient studies have been conducted on infrastructure and people. Furthermore, limited information is available on how to assess the transformation, which remains an unaddressed research question. NTP could meet several hurdles. However, through the measurement, assessment phases, and development tracking, success could be achieved., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alkhurayji et al.)

DNA gyrase and topoisomerase IV show great potential as targets for antibacterial medicines. In recent decades, various categories of small molecule inhibitors have been identified; however, none have been effective in the market. For the first time, we developed a series of disalicylic acid methylene/Schiff bases hybrids ( 5a-k ) to act as antibacterial agents targeting DNA gyrase and topoisomerase IV. The findings indicated that the new targets 5f-k exhibited significant antibacterial activity against Gram-positive and Gram-negative bacteria, with efficacy ranging from 75% to 115% of the standard ciprofloxacin levels. Compound 5h demonstrated the greatest efficacy compared to the other compounds tested, with minimum inhibitory concentration (MIC) values of 0.030, 0.065, and 0.060 μg/mL against S. aureus , E. coli , and P. aeruginosa . 5h had a MIC value of 0.050 μg/mL against B. subtilis , which is five times less potent than ciprofloxacin. The inhibitory efficacy of the most potent antibacterial derivatives 5f , 5h , 5i , and 5k against E. coli DNA gyrase was assessed. The tested compounds demonstrated inhibitory effects on E. coli DNA gyrase, with IC 50 values ranging from 92 to 112 nM. These results indicate that 5f , 5h , 5i , and 5k are more effective than the reference novobiocin, which had an IC 50 value of 170 nM. Compounds 5f , 5h , 5i , and 5k were subjected to additional assessment against E. coli topoisomerase IV. Compounds 5h and 5i , which have the highest efficacy in inhibiting E. coli gyrase, also demonstrated promising effects on topoisomerase IV. Compounds 5h and 5i exhibit IC 50 values of 3.50 µM and 5.80 µM, respectively. These results are much lower and more potent than novobiocin's IC 50 value of 11 µM. Docking studies demonstrate the potential of compound 5h as an effective dual inhibitor against E. coli DNA gyrase and topoisomerase IV, with ADMET analysis indicating promising pharmacokinetic profiles for antibacterial drug development., Competing Interests: Author SR was employed by company Apogee Pharmaceuticals. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Al-Wahaibi, Mahmoud, Alzahrani, Abou-Zied, Gomaa, Youssif, Bräse and Rabea.)

In recent years, the proliferation of Massive Open Online Courses (MOOC) platforms on a global scale has been remarkable. Learners can now meet their learning demands with the help of MOOC. However, learners might not understand the course material well if they have access to a lot of information due to their inadequate expertise and cognitive ability. Personalized Recommender Systems (RSs), a cutting-edge technology, can assist in addressing this issue. It greatly increases resource acquisition through personalized availability for various people of all ages. Intelligent learning methods, such as machine learning and Reinforcement Learning (RL) can be used in RS challenges. However, machine learning needs supervised data and classical RL is not suitable for multi-task recommendations in online learning platforms. To address these challenges, the proposed framework integrates a Deep Reinforcement Learning (DRL) and multi-agent approach. This adaptive system personalizes the learning experience by considering key factors such as learner sentiments, learning style, preferences, competency, and adaptive difficulty levels. We formulate the interactive RS problem using a DRL-based Actor-Critic model named DRR, treating recommendations as a sequential decision-making process. The DRR enables the system to provide top-N course recommendations and personalized learning paths, enriching the student's experience. Extensive experiments on a MOOC dataset such as the 100 K Coursera course review validate the proposed DRR model, demonstrating its superiority over baseline models in major evaluation metrics for long-term recommendations. The outcomes of this research contribute to the field of e-learning technology, guiding the design and implementation of course RSs, to facilitate personalized and relevant recommendations for online learning students., (© 2024. The Author(s).)

Objectives: Acquired hemophilia affects approximately one in 1 million people. Timely diagnosis is key to appropriate disease management and the prevention of life-threatening complications. Patients with this condition may initially be seen by inexperienced physicians and remain underdiagnosed for several years. This consensus statement is aimed at providing guidelines for all practitioners in the Kingdom of Saudi Arabia (KSA) to diagnose and manage acquired hemophilia A., Methods: This consensus statement reflects the opinions drafted by a group of hematology specialists, who used an explicit systematic process to identify areas of agreement and disagreement., Results: This consensus statement provides a guide for all practitioners in the KSA regarding the diagnosis of clinical presentation, relevance, characteristics of bleeding symptoms, and case management; it additionally provides guidance for non-specialists. All management aspects, including diagnosis and treatment modalities, are discussed., Conclusions: Patients with acquired hemophilia may initially be seen by physicians who lack appropriate expertise in diagnosing and managing this condition. This consensus statement from the premier experts on the disease in the KSA provides details for diagnosing and managing acquired hemophilia., (© 2024 The Authors.)

Background: Life-threatening blunt thoracic aortic injury (BTAI) typically occurs alongside multiple other traumatic injuries. Symptoms of BTAI can range from being asymptomatic in the case of intimal tears to becoming catastrophic in the case of uncontained aortic ruptures. The aim of this research was to examine the clinical outcomes for those who underwent thoracic endovascular aortic repair (TEVAR) in hospital settings.  Methods: A cross-sectional retrospective study was conducted using patient data that were extracted from Al-Noor Specialist Hospital, Makkah, Saudi Arabia, for the duration between January 2011 and December 2021. This study included data from all patients aged 18 and up who had been diagnosed with BTAI and had undergone TEVAR. The BTAI diagnoses were confirmed using CT scans. Logistic regression was utilized to identify predictors of patients' health status improvement and length of stay., Results: A total of 80 patients were involved. Around 50.0% (n=40) of the patients had grade 3 thoracic aortic injuries. The median duration of stay was 14.00 days (Interquartile range 21.00). Only one patient developed post-procedure complications (1.3%). Almost one-third (31.3%; n=25) of the patients required subclavian coverage. One patient developed intraoperative endoleak (1.3%). One patient developed an access site complication (1.3%). The mortality rate within 30 days of the operation was 1.3%. The vast majority of the patients (92.5%; n=74) showed improvement upon discharge from the hospital. The baseline patient characteristics and length of hospitalization had no effect on the improvement of patient status upon discharge or their length of stay (p>0.05)., Conclusion: Patients with BTAI have shown an excellent success rate with TEVAR and a low complication rate. Predictors of procedure success and length of stay need to be identified; however, this can't be done without larger-scale investigations. This can aid in the development of preventative measures that improve clinical outcomes for the patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, AlQurashi et al.)

Background: Diabetes mellitus is a chronic disease that can lead to depression and anxiety disorders if it is not controlled and managed properly. This study aimed to estimate the prevalence of depression and anxiety disorders among diabetic patients and to determine whether patient knowledge is a risk factor., Methods: The study included 220 patients with diabetes who attended the Diabetic Care Center. Socio-demographic data on the patients was collected. The Hospital Anxiety and Depression Scale questionnaire was used to assess patients' depression and anxiety levels. The Diabetes Knowledge Test 2 was used to assess the patients' knowledge of diabetes., Results: From 220 patients with diabetes, anxiety was detected in 78.2%. From the recordings of these patients with diabetes, it was observed that 32.7%, 29.5%, and 15.9% suffered from mild, moderate, and severe anxiety, respectively. Depression was diagnosed in 170 patients (77.2%), with the majority sowing a moderate degree (32.3%) of depression. Furthermore, 29.5% and 15.5% patients had recorded mild and severe degrees of depression, respectively. Patients' understanding of diabetes was inadequate in this study, with the majority of patients (70.5%) having a low level of overall diabetes knowledge. In terms of general knowledge of diabetes, 64.1% patients had a low knowledge level, whereas 74.5% patients had a low knowledge level related to insulin therapy., Conclusion: The patients' diabetes knowledge is significantly correlated with their anxiety and depression symptoms. Patients with diabetes should be regularly screened for anxiety and depression symptoms. Our findings indicate that the educational diabetes program could be a useful intervention for reducing depression and anxiety., Competing Interests: • Conflicts of Interest: No conflict of interest., (© 2024 Journal of Lifestyle Medicine.)

In the present study, the formation of a heterodimer involving both epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) has been explored as a potential therapeutic mechanism to inhibit the progression of breast cancer. Virtual screening using molecular docking resulted in the three hit compounds ( ZINC08382411 , ZINC08382438 , and ZINC08382292 ) with minimum binding scores and commonly binding to both receptors. Further, MD simulation analysis of these complexes illustrated the high stability of these compounds with EGFR and HER2. RMSD showed that ZINC08382411 displayed the most stable RMSD of 2 - 3 Å when bound to both receptors, suggesting to have strong compatibility with the active site of the receptor. Hydrogen bond analysis showed that ZINC08382411 forms the maximum number of H-bonds (2 to 3) in both EGFR and HER2 bound complexes, with the highest occupancy of 62% and 79%, respectively. Binding free energy calculation showed that ZINC08382411 possesses maximum affinity towards both the receptors with ΔG bind = -129.628 and -164.063 kJ/mol, respectively. This approach recognizes the significance of EGFR and HER2 in breast cancer development and aims to disrupt their collaborative signaling, which is known to promote the antagonistic behavior of cancer cells. By focusing on this EGFR/HER2 heterodimer, the study offers a promising avenue for identifying a potential candidate ( ZINC08382411) that may inhibit breast cancer cell growth and potentially improve patient outcomes. The study's findings may contribute to the ongoing efforts to advance breast cancer treatment strategies.Communicated by Ramaswamy H. Sarma.

This study evaluated the effectiveness of assistive technologies (ATs) through e-books in teaching practices aimed at enhancing language development among hard-of-hearing (HH) students. The study implemented an intervention consisting of four language aspects (phonemic awareness, writing, vocabulary, and reading comprehension) wherein the ATs' impacts on language development were assessed. Eighty HH students were divided into control and treatment groups and evaluated through pre- and post-tests. The results showed that the intervention led to significant changes in all four language aspects in both groups. Interestingly, the effect sizes were moderate in the control group but large in the treatment group, thus showing the efficiency and effectiveness of the developed intervention. These findings constitute useful evidence-based guidelines for implementing ATs to enhance teaching practices in the HH language setting.

Introduction The intricate connection between nutrition and compromised wound healing exposes patients to heightened risks of pressure ulcers, infections, and delayed recovery from wounds or traumatic injuries. In-depth scientific investigations have shed light on the potential of specialized nutritional supplements, combined with regular wound care, to significantly boost the management of pressure ulcers and the wound healing process. The study focuses on supplemental Vitamin C, Arginine, and Zinc due to their established roles in wound healing, aiming to assess the awareness and practice of healthcare workers in Saudi Arabia regarding these essential nutrients for effective wound management. This cross-sectional study aimed to assess awareness and practice among healthcare workers in Saudi Arabia regarding the use of supplemental Vitamin C, Arginine, and Zinc in managing wounds. Methods This study adopts a cross-sectional research design to explore the dynamics to assess the awareness and practice among healthcare workers about the use of supplemental Vitamin C, Arginine, and Zinc in managing wounds in Saudi Arabia. The research methodology encompasses developing and validating a questionnaire, data collection, and subsequent analysis. Thorough statistical analyses, encompassing descriptive statistics, validated assessment scales, and inferential statistics, were conducted using SPSS and Microsoft Excel to explore intricacy prevalence and severity relationships with various factors, maintaining a statistical power of 80% at a cutoff value of 0.05. Result In a cross-sectional survey of 510 healthcare professionals, the socio-demographic analysis revealed a predominant hospital workplace (61.56%), with pharmacists representing 10.19%, and comprehensive tabulation of response rates and p-values, while the knowledge and awareness assessment demonstrated varied understanding and perceptions of wound care supplements, including frequent encounters with pressure ulcers or wounds (36.5%), diverse awareness levels for Vitamin C, Arginine, and Zinc, with the collaboration and communication dynamics among healthcare workers, detailed in tabulated response rates and p-values. Conclusion The findings reveal a diverse understanding landscape, with varying levels of awareness, perceived effectiveness, and confidence in applying these supplements., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sheriff et al.)

Cancer and different types of tumors are still the most resistant diseases to available therapeutic agents. Finding a highly effective anticancer drug is the first target and concern of thousands of drug designers. In our attempts to address this concern, a new pyrazine derivative, 1-(5-bromopyrazin-2-yl)-1-[3-(trifluoromethyl)benzyl]urea (BPU), was designed via structural optimization and synthesized to investigate its anticancer/antitumor potential. The in-vitro anticancer properties of BPU were evaluated by MTT assay using selected cell lines, including the Jurkat, HeLa, and MCF-7 cells. The Jurkat cells were chosen to study the effect of BPU on cell cycle analysis using flow cytometry technique. BPU exhibited an effective cytotoxic ability in all the three cell lines assessed. It was found to be more prominent with the Jurkat cell line (IC 50  = 4.64 ± 0.08 µM). When it was subjected to cell cycle analysis, this compound effectively arrested cell cycle progression in the sub-G1 phase. Upon evaluating the antiangiogenic potential of BPU via the in-vivo/ex-vivo shell-less chick chorioallantoic membrane (CAM) assays, the compound demonstrated very significant findings, revealing a complementary supportive action for the compound to act as a potent anticancer agent through inhibiting blood vessel formation in tumor tissues. Moreover, the docking energy of BPU computationally scored - 9.0 kcal/mol with the human matrix metalloproteinase 2 (MMP-2) and - 7.8 kcal/mol with the human matrix metalloproteinase 9 (MMP-9), denoting promising binding results as compared to the existing drugs for cancer therapy. The molecular dynamics (MD) simulation outcomes showed that BPU could effectively bind to the previously-proposed catalytic sites of both MMP-2 and MMP-9 enzymes with relatively stable statuses and good inhibitory binding abilities and parameters. Our findings suggest that the compound BPU could be a promising anticancer agent since it effectively inhibited cell proliferation and can be selected for further in-vitro and in-vivo investigations. In addition, the current results can be extensively validated by conducting wet-lab analysis so as to develop novel and better derivatives of BPU for cancer therapy with much less side effects and higher activities., (© 2023. The Author(s).)

This study describes the discovery of a variety of quinoline2-one derivatives with significant antibacterial action vs a spectrum of multidrug-resistant Gram-positive bacterial strains, especially methicillin-resistant Staphylococcus aureus (MRSA). Compounds 6c, 6l, and 6o exhibited significant antibacterial activity versus the Gram-positive bacterial pathogens evaluated. In comparison to the reference daptomycin, compound 6c demonstrated the most effective activity among the assessed derivatives, with MIC concentrations of 0.75 μg/mL versus MRSA and VRE and 2.50 μg/mL against MRSE. We also reported on these compounds' biofilm and dihydrofolate reductase inhibitory activities. Compound 6c showed the greatest antibiofilm action in a dose-dependent way and a substantial decrease of biofilm development in the MRSA ACL51 strain at concentrations of 0.5, 0.25, and 0.12 MIC, with reductions of 79%, 55%, and 38%, consecutively, whereas the corresponding values for vancomycin were 20%, 12%, and 9%. These findings imply that these quinoline compounds could be used to develop a new category of antibiotic representatives to prevent Gram-positive drug-resistant bacterial strains., (© 2023. The Author(s) under exclusive licence to Sociedade Brasileira de Microbiologia.)

Background: Alpha-thalassemia (α-thalassemia) is one of the most common monogenic diseases in Saudi Arabia and is associated with significant morbidity. Premarital testing programs in Saudi Arabia reduce the burden of hemoglobinopathy disorders, and ongoing monitoring is required. We aimed to explore the molecular nature of α-globin genes and identify the most common genotypes and regions with a high risk of α-thalassemia in Saudi Arabia., Methods: This retrospective study was conducted between January 2021 and December 2022. Six hundred twenty-five samples from patients with microcytic hypochromic anemia in Saudi Arabia were analyzed using reverse dot blot hybridization (RDBH)-based multiplex-PCR, which screens for the known 21 mutations of α-globin genes., Results: Seven mutations in the α-globin gene were identified in 88.96% (556) patients. The most frequent abnormality of a-globin genes was -α 3.7 (62.3%), followed by α2 IVS1(-5nt) (20.7%) and α2 polyA-1 (α2 T.Saudi ) (14.1%). Interestingly, α2 polyA-2 (α2 T.Turkish ) was identified in Saudi and presented with -MED, causing Haemoglobin H disease. The incidence of α-thalassemia in Saudi Arabia's cities showed significant differences (P = 0.004). Jeddah City had the highest percentage of cases (25%), followed by Makkah (23%), Taif (13.3%), and Al-Ahassa (12.4%)., Conclusion: The study provides current knowledge about the molecular nature of α- thalassemia, highlights the common genotypes that could contribute to disease occurrence in the Saudi population, and sheds light on Saudi regions with a high incidence. It also recommends further studies in a larger population and with differently composed molecular assays to verify these findings., (© 2023. The Author(s).)

Background Adenoid hypertrophy is a common condition that can cause upper airway obstruction in children and adolescents, leading to various complications, including dental and maxillofacial abnormalities. However, parents may have limited knowledge of the orthodontic complications associated with this condition. Objective This study aimed to assess the knowledge and attitude of parents toward the orthodontic complications of untreated adenoid hypertrophy and to promote their awareness about this problem. Method This descriptive cross-sectional study involved 824 parents from all regions of Saudi Arabia. An online questionnaire was used to collect data on parents' demographics, their children's information, and their general knowledge about adenoid hypertrophy, including its symptoms, complications, and treatment. Results The study included 824 parents with a mean age of 36.78 ± 10.87 years, 73.2% of whom were women. Overall, only 6.2% (51.1 parents) had a good level of knowledge about adenoid hypertrophy. Conclusion The study highlights the importance of promoting awareness and educating parents about the orthodontic complications associated with adenoid hypertrophy. Greater awareness and understanding can help parents make better decisions for their children's health and well-being., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alzahrani et al.)

Background Cardiotoxicity, produced as an adverse effect of anticancer therapy, is a common issue during cancer treatment. Acute coronary syndrome, myocarditis, arrhythmias, or heart failure can all be symptoms of this issue. Little is known about its occurrence among Saudi Arabian cancer patients. This study aims to investigate factors linked to anticancer therapy-related cardiotoxicity. Methods A retrospective study was conducted from April 2020 to May 2022 at the King Khalid Hospital, Najran, Saudi Arabia. The study included adult cancer patients receiving anticancer therapy, regardless of their cardiovascular disease history. Univariate analysis was used to investigate factors associated with the occurrence of cardiotoxicity related to anticancer therapy. Results Of 78 patients receiving anticancer therapy, cardiotoxicity occurred in 12 (15.4%) patients. The mean age was 56.5 ± 13.4 years, with 33.3% aged over 65 years. Comorbidities included hypertension (44; 56.4%), diabetes (41; 52.6%), dyslipidemia (13; 16.7%), smoking (16; 20.5%), heart disease (6; 7.7%), trastuzumab use (9; 11.5%), and chronic kidney disease (2; 2.6%). The most common cancers were breast cancer and gastrointestinal cancer (27.6% each). Monoclonal anticancer agents 35 (46.1%) and alkylating agents 29 (38.2%) were commonly used chemotherapies. Cardiac protective agents were used in 16 (21.1%) of patients, with angiotensin-converting enzyme (ACE) inhibitors 15 (19.7%) and statins (13; 17.1%) being the most prescribed. Baseline ejection fraction (EF) was normal in 69 (90.8%) of cases. The follow-up duration was 1.93 ± 1.90 years. A drop in EF occurred in five (6.6%) of cases. Dyslipidemia (OR: 0.12; 95% CI: 0.03-0.47, p=0.002), previous heart disease (OR: 0.14; 95% CI: 0.02-0.81, p=0.029), and impaired baseline EF (p=0.029) were associated with increased risk of cardiotoxicity. Statin (OR: 0.22; 95% CI: 0.05 to 0.84, p=0.028) and antiplatelet agents (OR: 0.19; 95% CI: 0.03 to 1.01, p=0.051) were protective agents against cardiac toxicity. Conclusion Effective anti-cancer therapy may be accompanied by an increased risk of cardiotoxicity. In this study, a history of prior heart disease, dyslipidemia, low baseline ejection fraction, and the administration of multiple anticancer therapy agents was associated with cardiotoxicity. Proactive management strategies aimed at mitigating the potential cardiotoxic effects of anti-cancer therapies are crucial., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Badheeb et al.)

The study aimed to investigate the antitumor efficacy of anti-LMP1 antibodies in EBV-positive nasopharyngeal and stomach cell lines and xenograft models. The study also examined the NF-κB expression and cell cycle activation of NPC-serum-exosome-associated LMP1. Anti-LMP1 antibody treatment before or during cell implantation prevented tumor growth in nude mice. A small dose of antibodies resulted in complete tumor regression for at least three months after the tumors had grown in size. The consumption of antigen-antibody complexes by tumor cells limited tumor growth. In vitro experiments showed that anti-LMP1 antibodies killed EBV-positive NPC- or GC-derived epithelial cell lines and EBV-positive human B-cell lines but not EBV-negative cell lines. Treatment with anti-LMP1 reduced NF-κB expression in cells. The animal model experiments showed that anti-LMP1 inhibited and prevented NPC- or GC-derived tumor growth. The results suggest that LMP1 antibody immunotherapy could cure nasopharyngeal cancer, EBV-positive gastric carcinoma, and EBV-associated lymphomas. However, further validation of these findings is required through human clinical trials.

Zinc molybdate nanoparticles with molybdate are synthesized through green method with different salt precursors using Moringa oleifera leaf extract. Those nanoparticles had structural, vibrational, and morphological properties, which were determined by X-ray diffraction (XRD). The crystalline size of synthesized zinc molybdate was 24.9 nm. Fourier transform infrared (FTIR) spectroscopy and field emission scanning electron microscopy (FE-SEM) clearly showed the attachment of molybdate with ZnO. The synthesized nanomaterial was also characterized through UV-visible spectroscopy which had 4.40 eV band gap energy. Those nanoparticles were also characterized via thermogravimetric analysis (TGA-DTA) and photoluminance spectroscopy (PL). ZnMoO 4 had photocatalytic property via methylene blue dye. After 190 minutes, the dye changed to colourless from blue colour. The degradation efficiency was around 92.8%. It also showed their antibacterial effect via Escherichia coli and Staphylococcusaureus bacterial strains. In the presence of light and air, nanoparticles of ZnMoO 4 inhibit the growth of cells of E. coli and S. aureus bacterial strains because of ROS (reactive oxygen species) generation. Because of the formation of singlet oxygen (O 2 ∗ - ), hydrogen oxide radical (-OH ∗ ), and hydrogen peroxide (H 2 O 2 ), ZnMoO 4 showed photodegradation reaction against aq. solution of methylene blue dye at 6 pH with constant time interval. With time, the activity of ZnMoO 4 also decreased because of the generation of a layer of hydrogen oxide (-OH) on nanomaterial surface, which could be washed with ethanol and distilled water. After drying, the catalytic Zinc molybdate nanoparticles could be reused again in the next catalytic reaction., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Sanjeev Machindra Reddy et al.)

Background In this study, we aimed to evaluate the knowledge and awareness about cervical cancer, human papillomavirus (HPV) and its vaccine among women living in the western region of Saudi Arabia. Methodology Using a cross-sectional online survey, this study assesses the knowledge and awareness level of HPV and the risk factors of cervical cancer among women living in the western region of Saudi Arabia. The design of the questionnaire is based on several earlier studies in different populations. Results The total completed responses include a sample of 624 that was subjected to statistical analysis; the analysis showed that only 34.6% were aware of HPV. Participants who belonged to the 21-30 and 31-40-year-old groups had comparatively more awareness than other age groups (p<0.001). Most (83.8%) believed that it would cause cervical cancer. Less than half (45.8%) knew that there is a vaccine against HPV infection. When we assessed the willingness to receive the vaccine, it was found that 75.8% were willing to take it. Conclusions The study found that women in the western region of Saudi Arabia have limited knowledge of cervical cancer and HPV and its vaccine. There is a need to educate and promote awareness of HPV and its complications for women in the western region of Saudi Arabia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alkhaldi et al.)

Essential oils (EOs) obtained by hydro-distillation from different parts of twigs (EOT), leaves (EOL), and fruits (EOF) of Eucalyptus gunnii Hook. f. were screened for their chemical composition, insecticidal, repellence, and antibacterial properties. Based on GC and GC/MS analysis, 23 constituents were identified across the twigs, leaves, and fruits, with 23, 23, and 21 components, respectively. The primary significant class was oxygenated monoterpenes (82.2-95.5%). The main components were 1,8-cineole (65.6-86.1%), α-terpinyl acetate (2.5-7.6%), o-cymene (3.3-7.5%), and α-terpineol (3.3-3.5%). All three EOs exhibited moderate antibacterial activities. EOL was found to have higher antibacterial activity against all tested strains except Dickeya solani (CFBP 8199), for which EOT showed more potency. Globally, Dickeya solani (CFBP 8199) was the most sensitive (MIC ≤ 2 mg/mL), while the most resistant bacteria were Dickeya dadantii (CFBP 3855) and Pectobacterium carotovorum subsp. carotovorum (CFBP 5387). Fumigant, contact toxicity, and repellent bioassays showed different potential depending on plant extracts, particularly EOT and EOL as moderate repellents and EOT as a medium toxicant.

Background and Objectives: Intragastric balloon (IGB) is a safe option for obesity management. However, studies determining the factors influencing the procedure's outcomes are scarce. Therefore, our goal was to determine the factors affecting weight reduction after IGB insertion., Materials and Methods: This retrospective study included 126 obese patients who underwent IGB treatment using the ORBERA ® Intragastric Balloon System. Patients' records were retrieved; and demographic data, initial body mass index (BMI), complications, compliance with both diet and exercise programs, and percentage of excess weight reduction were recorded., Results: The study included 108 female (85.7%) and 18 male (14.3%) patients. The mean age was 31.7 ± 8.1 years. The percentage of excess weight loss (EWL) was 55.8 ± 35.7%. The mean weight loss was 13.01 ± 7.51 kg. A significant association was found between EWL and age, initial weight, initial body mass index, and the number of pregnancies. No major complications were observed. However, the balloon had to be removed early in two patients (1.59%) due to its rupture and in two other patients (1.59%) due to severe gastritis., Conclusions: IGB therapy is a safe and effective option for obesity management, associated with low rates of complications. The EWL after IGB insertion is significantly higher among older patients, those with a relatively low initial body mass index, those with a longer duration of IGB insertion, and female patients with less parity. Larger prospective studies are needed to support our results.

Background: COVID-19 preventive measures required a drastic shift to online teaching-learning in most of countries. Institutions used different combinations of live online lectures (synchronous) requiring students to attend the class in real-time, as well as recorded lectures uploaded by the instructors to be accessed by students as per their own convenience (asynchronous). We undertook this study to assess and compare the perceptions of students regarding their learning experiences in the synchronous versus asynchronous mode of instruction using  their teaching-learning during the compulsory online mode of instruction at the peak of the COVID-19 pandemic., Methodology: This cross-sectional questionnaire-based study received responses from 122 final-year medical students studying at the College of Medicine, King Khalid University, Abha, Saudi Arabia. An online 5-point Likert scale-based questionnaire was used to collect data regarding experience and perception towards synchronous and asynchronous learning. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P-value less than 0.05 was considered significant., Result: All the students found both synchronous and asynchronous learning to be equally satisfying, enjoyable and comfortable. No statistically significant difference was found when both the methods were analyzed for enhancement of knowledge. The students opined that asynchronous learning helped them manage their time better whereas synchronous learning encouraged more interaction during the live lectures., Conclusion: Overall, the students' perceptions regarding both synchronous and asynchronous online learning were positive. As both methods have their advantages/limitations, a mix of both synchronous and asynchronous methods may be adopted depending upon the content of the topic and the desired learning outcomes., (© 2023. The Author(s).)

(1) Background: Cystic echinococcosis is a zoonotic helminth disease that causes severe economic losses. The study aimed to assess the prevalence and viability of cystic echinococcosis in examined camels. In addition, assessing the histological, morphological, oxidative, and antioxidant state related to the cystic echinococcosis infection; (2) Methods: The study was performed on 152 slaughtered dromedary camels between March and September 2022 at El-Basatin abattoir in Cairo Governorate, Egypt; (3) Results: The results revealed that the prevalence of hydatidosis was 21.7% in slaughtered camel and the highest infection rate observed in lungs was 87.87%, while it was 9% in livers. Camels' liver infections were rare, whereas their lung infections were more common. By comparing to non-infected camels, the level of MAD was significantly increased with hydatid cysts infection, while the level of GSH, SOD and CAT was significantly decreased. Histopathological section of camel cyst revealed layered membranes surrounded by a zone of cellular infiltration and an outermost fibrous tissue reaction. In addition, there was evidence of atelectasis, emphysema, hemorrhage, congestion, and fibrosis in the surrounding tissues. Nonetheless, the degeneration and necrosis of hepatocytes and other pathological alterations in liver cyst sections were remarkably comparable to those seen in the lungs. Furthermore, calcification was detected.

Introduction: The aim of this study was to evaluate the effects of baseline anemia and anemia following revascularization on outcomes in patients with unprotected left main coronary artery (ULMCA) disease., Methods: This was a retrospective, multicenter, observational study conducted between January 2015 and December 2019. The data on patients with ULMCA who underwent revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) were stratified by the hemoglobin level at baseline into anemic and non-anemic groups to compare in-hospital events. The pre-discharge hemoglobin following revascularization was categorized into very low (&lt;80 g/L for men and women), low (≥80 and ≤119 g/L for women and ≤129 g/L for men), and normal (≥130 g/L for men and ≥120 g/L for women) to assess impact on follow-up outcomes., Results: A total of 2,138 patients were included, 796 (37.2%) of whom had anemia at baseline. A total of 319 developed anemia after revascularization and moved from being non-anemic at baseline to anemic at discharge. There was no difference in hospital major adverse cardiac and cerebrovascular event (MACCE) and mortality between CABG and PCI in anemic patients. At a median follow-up time of 20 months (interquartile range [IQR]: 27), patients with pre-discharge anemia who underwent PCI had a higher incidence of congestive heart failure (CHF) (p &lt; 0.0001), and those who underwent CABG had significantly higher follow-up mortality (HR: 9.85 (95% CI: 2.53-38.43), p = 0.001)., Conclusion: In this Gulf LM study, baseline anemia had no impact upon in-hospital MACCE and total mortality following revascularization (PCI or CABG). However, pre-discharge anemia is associated with worse outcomes after ULMCA disease revascularization, with significantly higher all-cause mortality in patients who had CABG, and a higher incidence of CHF in PCI patients, at a median follow-up time of 20 months (IQR: 27)., (© 2023 S. Karger AG, Basel.)

In the present study, we utilized Stevia rebaudiana L. (SRLe) extract to in situ biosynthesize nanoscale alpha hematite (α-Fe 2 O 3 ) nanoparticles (NPs) with potent antioxidant, antimicrobial, and anticancer properties. SRLe-α-Fe 2 O 3 was characterized using physiochemical analyses, including UV/Vis, FTIR, XRD, DLS, EDX, SEM, and TEM studies. Among tested solvents, CHCl 3 /MeOH (2:1 v / v ) SRL extract (least polar solvent) contained the highest EY, TPC, and antioxidant capacity of ~3.5%, ~75 mg GAE/g extract, and IC 50 = 9.87 ± 0.7 mg/mL, respectively. FTIR confirmed the engagement of coating operation to the colloidal α-Fe 2 O 3 NPs. TEM, SEM, and DLS revealed that SRLe-α-Fe 2 O 3 has a spherical shape, uniform size distribution with aggregation for an average size of ~18.34 nm, and ζ = -19.4 mV, forming a repulsive barrier that helped to improve stability. The synthesized nanoparticles displayed considerable antibacterial activity against E. coli and S. aureus bacterial growth, and exhibited superior activity against the A549 lung cancer cell lines. These findings indicate that the increased availability of bioactive substances with antioxidant properties of SRLe makes it a potentially interesting material for the preparation of biologically active compounds and green synthesis of nanoparticles.

Background: Road traffic injuries (RTIs) are the second leading cause of mortality in Saudi Arabia. The high rate of RTIs puts a strain on rehabilitation services. Yet, little is known of the economic burden of nonfatal RTIs and rehabilitation services. This study, therefore, aims to describe the annual rehabilitation costs associated with RTIs at a local trauma center., Materials and Methods: This study was conducted among all the 17 years or older patients hospitalized at King Abdulaziz Medical City in Riyadh following RTIs and required rehabilitation care. We included 299 patients who met the inclusion criteria and were followed for one year after discharge from the index hospital. The data was abstracted through retrospective review of patients' medical records. All rehabilitative services utilized by the healthcare system were recorded. To describe the economic burden, the mean, median, standard deviation, and interquartile range (IQR) were calculated. Total costs were aggregated for all patients to estimate overall costs., Results: The study population was relatively young (31 years ± 14.4). The total annual rehabilitation cost of patients was Saudi Riyals (SAR) 6,113,781 (IQR: 20,589.3 - 3,125 = 17,464.3), and the average for each patient was SAR 20,447 (median = 7875). Patients aged 40-59 years and ≥60 years accounted for the highest average rehabilitation cost of SAR 31,563.99 and 32,639.21, respectively. Rehabilitation visits incurred the highest cost (mean SAR 1,494,124), followed by bed utilization which cost SAR 1,311,972 and radiology examination at SAR 1,032,261. The cost of motorcycle injuries was relatively higher (SAR 44,441.0) than other injury mechanisms., Conclusion: This study underlines the economic burden of rehabilitation services resulting from RTIs. Public health interventions are needed to reduce the burden of RTIs by dealing with their preventable causes and improving road safety measures. These findings may be useful to policymakers and researchers to support and improve rehabilitation services in Saudi Arabia., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family and Community Medicine.)

Background: Low-cost, automated interventions that increase knowledge and skills around diet and lifestyle modifications are recommended for cardiovascular disease risk reduction., Methods: We initiated a quality improvement program to assess the impact of a web-based diet and lifestyle intervention utilizing short animated videos in adults with high blood pressure (BP) at a primary care clinic in Saudi Arabia. We enrolled adults with elevated BP, not on BP medications, who were identified using the electronic medical record. We delivered a web-linked diet and lifestyle intervention using animated videos covering diet and lifestyle topics. Videos and reminders were sent weekly for 5 weeks. Outcomes were proportion who engaged in the program, returned for a repeat BP within 3 months, and change in BP., Results: We enrolled 269 adult participants, with a mean (SD) age of 41.6 (12.4) years; 77% were male. At the conclusion of the pilot, we demonstrated a high level of engagement: overall, 69% of materials were viewed and 67% of patients returned for BP. Patients who returned had a mean (SD) baseline systolic BP of 138.0 (7.2) mm Hg and a large mean reduction in systolic BP from baseline, -10.5 mm Hg (12.4; P < 0.001)., Conclusions: Overall, the feasibility of a video-assisted, web-based, diet and lifestyle intervention as a support tool for hypertension management demonstrated a high participation rate and a high return rate for reassessment of BP. These findings suggest that this low-cost, automated intervention may have a great potential as a scalable tool for blood pressure management. However, randomized trials to understanding the effectiveness of the support tools are needed., (© American Journal of Hypertension, Ltd 2021. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Smoking is a psychosocial problem regarding its causes mainly. In primary health care units, depression is the most common problem that affects the whole body and arises with physical, emotional, and cognitive symptoms. This study aimed to determine the prevalence rate of tobacco smoking and depressive symptoms among male medical students of Albaha university. Also, to investigate the association between tobacco smoking and depressive symptoms among male medical students of Albaha university., Method: A cross-sectional study was conducted on All the male medical students in the all-academic year levels of Al-Baha medical college using a self-administrated questionnaire., Results: Two hundred and eight medical students completed the study. About half of the participants (49.5%) weren't smokers. More than two-thirds (69.5%) started smoking in the first academic year. Our statistical analysis results reported; a significant correlation regarding the marital status (P-value = 0.000). The abnormality was significantly higher among current smokers (P-value = 0.013) and markedly lower among nonsmokers (P-value = 0.004). Regarding types of smoking, cigarette smokers were seriously depressed (P-value = 0.000)., Conclusion: There is a relationship between smoking and depressive state among medical students. Researches must be conducted to explain this relation of depression symptoms with tobacco and not to increase the prevalence of smoking by helping students quit smoking., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Family Medicine and Primary Care.)

According to the elevated infection mortality risks, the incidence of coronavirus disease 2019 (COVID-19) could be raised in rheumatoid arthritis patients with end-stage renal disease (ESRD). Our objectives are to describe the impact of COVID-19 infection on rheumatoid arthritis patients with end-stage renal disease and to identify the risk of in-hospital mortality, comorbid conditions. and the proper way to deal with this category. It was a retrospective analysis of COVID-19 patients in Saudi Arabia from March 1, 2020 to April 27, 2020 and from May 27, 2020 to August 20, 2020. Of 10,482 patients with COVID-19, 419 had ESRD. We assessed main (in-hospital death) outcomes and secondary (mechanical breathing and residence) outcomes. Patients with ESRD were aged and more comorbid disorders. Rheumatoid arthritis patients with ESRD were aged. ESRD rheumatoid arthritis patients have a higher hospital mortality risk relative to rheumatoid arthritis patients not getting complicated with ESRD (31.7% vs. 25.4%, chances 1.38, and 95% trust range 1.12-1.70). After population and comorbid conditions had changed, the rate of rise stayed the same (changed chances: 1.37, 1.09-1.73). In both the crude and modified study (1.62, 1.26-2.07; vs. 1.57, 1.22-2.02), chances for the period of stay of seven or more days have been higher inside a group than in the non-ESRD group. Old age, respiratory support, lymphopenia, and elevated blood urea nitrogen and low serum ferritin were the independent contributing factors for the in-hospital mortality of ESRD rheumatoid arthritis patients infected with severe acute respiratory syndrome coronavirus 2.

Objective: To present the interim findings from a national study investigating the safety and efficacy of convalescent plasma (CP) containing detectable IgG antibodies as a treatment strategy for severe coronavirus disease 2019 (COVID-19)., Trial Design and Participants: An open label, two-arm, phase-II clinical trial conducted across 22 hospitals from Saudi Arabia. The intervention group included 40 adults (aged ≥18 years) with confirmed severe COVID-19 and the control group included 124 patients matched using propensity score for age, gender, intubation status, and history of diabetes and/or hypertension. Intervention group included those (a) with severe symptoms (dyspnea; respiratory rate, ≥30/min; SpO 2 , ≤93%, PaO2/FiO2 ratio, <300; and/or lung infiltrates >50% within 24-48 h), (b) requiring intensive care unit (ICU) care or (c) experiencing life-threatening conditions. The control group included confirmed severe COVID-19 patients of similar characteristics who did not consent for CP infusion or were not able to receive CP due to its nonavailability., Interventions: The intervention group participants were infused 300 ml (200-400 ml/treatment dose) CP at least once, and if required, daily for up to 5 sessions, along with receiving the best standard of care. The control group only received the best standard of care., Outcomes: The primary endpoints were safety and ICU length of stay (LOS). The secondary endpoints included 30-day mortality, days on mechanical ventilation and days to clinical recovery., Results: CP transfusion did not result in any adverse effects. There was no difference in the ICU LOS (median 8 days in both groups). The mortality risk was lower in the CP group: 13% absolute risk reduction ( P = 0.147), hazard ratio (95% confidence interval): 0.554 (0.299-1.027; P = 0.061) by log-rank test. There was no significant difference in the days on mechanical ventilation and days to clinical recovery., Conclusion: CP containing detectable antibodies is a safe strategy and may result in a decrease in mortality in patients with severe COVID-19. The results of the completed trial with a larger study sample would provide more clarity if this difference in mortality is significant., Trial Registration: ClinicalTrials.gov Identifier: NCT04347681; Saudi Clinical Trials Registry No.: 20041102., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Saudi Journal of Medicine & Medical Sciences.)

Background Congenital heart disease (CHD) is common in patients with Down's syndrome (DS), rendering them at risk of significant mortality and morbidity. However, all patients with confirmed DS must undergo further investigation for a cardiac anomaly early in their lives. Objective To define frequency and patterns of CHD among children with DS in Northwest, Saudi Arabia (SA). Methods A five-year chart review study was conducted in Northwest SA between January 2015 and June 2019. We included all children referred to the pediatric cardiology clinic with a confirmed diagnosis of DS and CHD. Children were identified in the clinic's database, and charts were reviewed retrospectively.  Results Among 851 patients with CHD, 53 were identified with DS. Male patients represented 62.3%, while female patients represented 37.7%. The median patients' age at the time of diagnosis was two days, with most patients diagnosed before 28 days old (67.9%). This study found that atrial septal defect (ASD) and patent ductus arteriosus (PDA) were the most common isolated lesions (37% of isolated cases), while the most common combined lesions were ASD, ventricular septal defect (VSD), and PDA, as well as combined ASD and VSD. Female gender was significantly associated with higher percentage of VSD (p = 0.031) more than male. While male patients had significantly higher percentages of ASD and valvular anomalies than female patients (p = 0.019 and 0.033, respectively). Conclusions The patient's gender was significantly associated with some types of CHD. Both ASD and valvular lesions were more common among males, while VSD was more common among female patients, no gender differences were detected regarding the other types of CHD., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Ghmaird et al.)

Background: The one-stage assay is the most common method to measure factor VIII activity (FVIII : C) in hemophilia A patients. The chromogenic assay is another two-stage test involving purified coagulation factors followed by factor Xa-specific chromogenic substrate., Aim: This study aimed to assess the discrepancy and correlation between the chromogenic and one-stage assays in measuring FVIII : C levels in hemophilia patients receiving Extended Half-Life Elocta® as a recombinant extended half-life coagulation factor., Methods: We performed a study comparing the measurements of FVIII : C levels by the chromogenic versus the one-stage assays at different drug levels. Data of FVIII : C levels, dosage, and the time interval from administration to measurement were retrieved from the hospital records. The correlation, mean differences, and discrepancy between the two assays were calculated. The linear regression analysis was used to predict the time interval till reaching 1% FVIII : C., Results: Fourteen patients with 56 samples were included in the study. Of them, 13 patients were receiving Elocta® as a prophylactic, while one was receiving Elocta® on demand. One-third of these samples showed a discrepancy between the chromogenic and one-stage assays. The two assays were well correlated. Mean differences were significant at the individual and the time interval level. The time since the last Elocta® injection could significantly predict FVIII : C levels ( β  = 0.366, P < 0.001)., Conclusion: Our findings suggested a significant difference between both methods; the FVIII : C levels measured by the one-stage assay were less than those estimated by the chromogenic assay. However, the measurements of FVIII levels by the two assays were well correlated but discrepant in one-third of the samples. The levels of FVIII : C reach 1% after 5.4 days since the last Elocta® administration., Competing Interests: The authors state that they have no conflicts of interest., (Copyright © 2020 Tarek M. Owaidah et al.)

Mitochondrial neurogastrointestinal encephalomyopathy syndrome is a rare autosomal recessive multisystem disorder caused by nuclear TYMP gene mutations, which leads to deficiency in thymidine phosphorylase enzyme. This deficiency then leads to mitochondrial dysfunction, which causes the features characteristic of this syndrome, including severe muscle wasting, gastrointestinal dysmotility, leukoencephalopathy, peripheral neuropathy, and ophthalmoplegia. Here, we present a case series of 3 patients with mitochondrial neurogastrointestinal encephalomyopathy from Saudi Arabia who underwent allogeneic stem cell transplant at King Faisal Specialist Hospital (Riyadh, Saudi Arabia). Two patients died within the first year of transplant, and the third is still alive but without improvement in clinical features. Allogeneic hematopoietic stem cell transplant-related mortality appears to be high; this may at least be partially related to established end-organ effects with decreased performance status. Although allogeneic hematopoietic stem cell transplant clearly affects correction of genetic and biochemical defects in mitochondrial neurogastrointestinal encephalomyopathy, its ability to reverse or improve established clinical manifestations has not been proven.

Purpose: As the burden of cancer on the population and the health care system continues to increase with more complicated treatment options, the need for multidisciplinary teams to be as efficient as possible becomes more vital. Our study aimed to evaluate the consistency of GI Tumor Board (GI TB) recommendations with international guidelines, the adherence of physicians involved in patient care to TB recommendations, and the impact on the management of patients., Methods: A prospective cohort study was conducted from January to June 2016 at our institution, which is a major tertiary hospital that provides comprehensive cancer care. All cases presented at the GI TB during this period were included. Data regarding adherence to National Comprehensive Cancer Network guidelines, adherence to TB recommendations, and changes made to the management of patients were collected weekly from the GI TB in a data collection form., Results: Of the 104 patients included, 57 (55%) were males and the median age was 58 (16 to 85) years. Colorectal cancer was the most common diagnosis, in 65 patients (63%). Nearly one-half of cases (45%) were stage IV cancers. Starting new treatment was recommended for 72 patients (69%). Further investigations were requested for 15 patients (14%). For imaging, 24 recommendations (23%) were made. Adherence to National Comprehensive Cancer Network guidelines was observed in 97% of total recommendations. New findings were found in pathology (11%), radiology (13%), and staging (4%). Management plans were changed in 37 cases (36%). Over a 3-month period after presentation to the GI TB, most of the recommendations (87%) were performed., Conclusion: A multidisciplinary tumor board enhances the adherence to guidelines and has an impact on patient management in approximately one-third of patients. Among physicians, adherence to recommendations of the TB was high.