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Sarah Albilal,1,* Mohammad S Shawaqfeh,2– 4,* Salwa Albusaysi,5 Lolwa Fetyani,2,3 Fai Alnashmi,2,3 Shaden D Alshehri,2,3 Nataleen A Albekairy,6 Amal Akhulaif,2 Lamees Alzahrani,2 Mariah Alwuhayde,2 Aiman A Obaidat,2,3,7 Abdulkareem M Al Bekairy1– 3,* 1Department of Pharmaceutical Care, King Abdulaziz Medical City-Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; 2College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; 4Department of Pharmacy Practice, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia; 6College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 7Department of Pharmaceutical Sciences, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabi*These authors contributed equally to this workCorrespondence: Abdulkareem M Al Bekairy, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Tel +966505550055, Email bekairya@ngha.med.sa; bekairy@gmail.com Mohammad S Shawaqfeh, College of Pharmacy, Department of Pharmacy Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, Tel +966502590643, Email shawaqfehm@ksau-hs.edu.sa; Shawaqfehms@gmail.comPurpose: Tacrolimus is a calcineurin inhibitor that suppresses immunity by inhibiting T-lymphocyte activation. It has a high intra- and inter-patient variability in its pharmacokinetics. Therefore, therapeutic drug monitoring is required to individualize the dose. High tacrolimus trough level variability is associated with a higher risk of adverse effects. In practice, the initial dosing and sampling time of tacrolimus levels is not standardized, which may result in resource wastage, frequent blood sampling, and a longer time to achieve therapeutic levels. The aim of this study was to evaluate tacrolimus trough level variation and its correlation to clinical outcomes and consequences.Patients and Methods: A retrospective cohort study At King Abdulaziz Medical City in Riyadh, Saudi Arabia, 01/01/2018 to 31/12/2021. Inclusion Criteria: > 18 years old solid organ transplant patients who received tacrolimus as part of their initial immunosuppression regimen. Tacrolimus initial dosing, trough levels, and dose adjustments were recorded during the early post-transplantation period (first 10 days). The coefficients of variation (CV%) in tacrolimus doses and trough concentrations were calculated and compared for different demographics and clinical characteristics.Results: The higher coefficient of variation in dose and trough level is associated with different demographic and clinical factors that will predict the incidence of adverse events. In our study, there was a significant increase in adverse effect reporting in the high variability group but was not clear for the risk of graft function, acute rejection, or infections.Conclusion: The variation in trough levels is associated with clinical consequences. Therefore, better dosing strategies can be modified to reduce the variation (fluctuation) which is associated with poor outcomes.Keywords: concentration, variability, monitoring, clinical, therapeutic

Background and objective Shared decision-making (SDM) in healthcare has transitioned from a paternalistic model to a collaborative approach, particularly significant in chronic disease management. This shift focuses on aligning healthcare decisions with patient preferences and values, thereby enhancing patient engagement and treatment adherence. However, patient preferences regarding involvement in SDM vary widely, influenced by demographic, disease-specific, psychological, cultural, and social factors. This study aimed to explore patient preferences related to SDM in chronic disease management in Saudi Arabia, by assessing attitudes toward SDM, the impact of decision aids, and the role of clinician communication in influencing these preferences. Methods A cross-sectional survey design was employed, involving 409 adult outpatients with chronic diseases attending four public hospitals in Saudi Arabia. Participants were selected using purposive and convenience sampling. The survey, translated into Arabic, collected demographic data and information on preferences and experiences in decision-making, communication, and information sharing. The data were analyzed using SPSS Statistics (IBM Corp., Armonk, NY) to identify patterns and correlations. Results Key findings indicated a strong preference among the participants for involvement in treatment decisions (n=303, 74.2%) and clear communication using layman's terms (n=338, 82.6%). Major barriers to active participation in SDM included lack of time during appointments (n=275, 67.2%), difficulty understanding medical terminology (n=220, 53.9%), and feeling intimidated to ask questions (297, 72.6%). Comfort in SDM was highest in the age group of 41-50 years [mean=4.16, standard deviation (SD)=28.44; F=2.3287, p=0.0739]. Patient satisfaction was significantly higher in the age group of 18-30 years (mean=3.42, SD=1.09; F=3.0503, p=0.0284). Conclusions Our findings highlight the need for incorporating patient preferences into chronic disease management strategies to enhance engagement and satisfaction., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee at Imam Abdulrahman Bin Faisal University issued approval 8. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alanzi et al.)

Background Autoimmune hepatitis (AIH) is a chronic liver disorder caused by the immune system targeting liver cells. The etiology of AIH remains undefined. Therefore, we aim to explore the relationship between cigarette smoking and AIH.  Methods A retrospective study was done at the Department of Medicine, King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Forty-six inpatients and outpatients managed at KAUH from 2016 to 2021 and diagnosed with AIH were included. Data about patients' age, gender, smoking state, type of liver disease, and any other autoimmune disease were collected. Results In all, 10.9% (n = 5) of patients were active smokers, and 60.0% (n = 3) used cigarettes. The median number of cigarettes smoked per day was 17, while 56.5% (n = 26) had a positive family history of smoking, and 41.3% (n = 19) were passive smokers. Of them, 39.1% (n = 18) had at least one complication of AIH, such as liver cirrhosis, which is the most frequent complication (61.1%; n = 11), followed by esophageal varices (22.2%; n = 4), liver fibrosis (5.6%; n = 1), and fatty liver (5.6%; n = 1). The presence of any complication was not associated with patients' demographics or smoking status. On the other hand, liver cirrhosis was significantly higher among currently active smokers. Conclusion No relationship was found between smoking and the AIH outcomes. Future multi-center studies on larger samples are needed., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee of King Abdulaziz University issued approval HA-02-J-008. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alarawi et al.)

A well-aligned dentition is more conducive to periodontal health, which is necessary for successful orthodontic therapy. Maintaining good dental hygiene is crucial for effective treatment, and patient cooperation, education, motivation, and attitude are all important components. Orthodontists must routinely check in with their patients to see whether they are maintaining their oral hygiene and if they are using any additional assistance. Negligence on the part of the patient may be the cause of poor treatment outcomes. This study aims to show how patient education can affect treatment outcomes and the development of a functional, aesthetically pleasing, and healthy dentition. Aim This study aims to investigate awareness, attitude, and periodontal health knowledge among orthodontic patients. Objectives The study explores the level of awareness and knowledge regarding periodontal health among orthodontic patients, examining its correlation with factors such as age, attitude, and duration of orthodontic treatment. Additionally, it aims to gauge the extent of education received by orthodontic patients regarding proper oral hygiene practices and the potential repercussions of neglecting them. Methods A questionnaire-based study with a cross-sectional design was performed in Jeddah, Saudi Arabia. A total of 428 participants were randomly selected from several private orthodontic clinics and hospitals. The participants in the study were individuals currently undergoing treatment with fixed orthodontic appliances. Information was gathered using a self-administered questionnaire. Results The patients undergoing orthodontic treatment have a moderate understanding of periodontal disease about dental plaque. The level of awareness of periodontal health was 41%, and the level of knowledge about periodontal health was 51%. When it came to periodontal health, adult orthodontic patients had a positive attitude toward fixed orthodontic treatment (mean score = 0.75). Subjects' attitudes regarding fixed orthodontic treatment were significantly impacted by the patient's consistency with his/her dental checkups (p value = 0.02). Conclusion The patients' periodontal health awareness was moderate, while their periodontal health knowledge was fair. Orthodontic patient's awareness levels, as well as knowledge levels, showed significant differences in age and duration but not sex. Results showed no significant difference among the attitude levels of orthodontic patients and age, sex, and duration., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Marusamy et al.)

Introduction and Importance: Cecal volvulus is a rare intestinal pathology that occurs due to abnormal cecum mobility associated with spectrum of complications. It is usually manifested in adults. However, on extremely rare occasions, it occurs in pediatrics. We presented a case of cecal volvulus demonstrating the significance of early diagnosis and treatment to reach successful outcomes., Case Presentation: A 12 year old boy who presented to the emergency department for clinical evaluation for acute abdomen. History and clinical examination was suggestive of acute bowel obstruction. Abdominal x-ray showed a large, distended gas filled viscus with base pointed towards the right lower quadrant. On the bases of radiological investigations, diagnosis of cecal volvolus made. Accordingly, the patient underwent emergency exploratory laparotomy. The post operative course was uneventful and was discharged in stable condition., Clinical Discussion: Cecal volvulus is an extremely rare manifestation of intestinal obstruction and malrotation. The clinical presentation of cecal volvulus depending on the duration and extent of the involvement of cecal malrotation The exact pathogenesis of cecal volvulus is unclear. However the association of the embryological development of the colon, affects the attachment to the posterior parietal peritoneum after ordinary anatomical rotation of 270°. The core-stone management of cecal volvulus is surgical approach., Conclusion: Cecal volvulus requires a high index of suspicion and delicate care by the pediatric surgeon as it is considered an extremely rare entity in this age group. We highlighted the significance of early diagnosis, surgical treatment and the possibility of developing postoperative complications if left untreated., 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 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Clinical assessment of progression of non-carious cervical lesions (NCCLs) is currently based on subjective methods. We hypothesize that 3D digital intraoral scanners (IOS) can provide quantitative outcomes for objective measuring and monitoring of NCCLs. This in vitro study verified the reliability of IOS to monitor dental structure loss of simulated NCCLs, in comparison to a reference bench-top 3D optical profilometer (BTS)., Methods: NCCLs of different severity levels (early, moderate, or severe, n = 150) were simulated in a preceding study. Impressions of the lesions were taken and scanned with both BTS (ProScan; Scantron) and IOS (TRIOS4; 3Shape). Generated 3D images were analyzed for volumetric tooth loss (mm 3 ) by superimposition followed by subtraction analysis. ProForm (Scantron) and WearCompare (Leeds Digital Dentistry) software were used in association to BTS and IOS, respectively. Agreement was assessed using intraclass correlation coefficient (ICC, alpha=0.05) and Bland-Altman plots., Results: ICC (confidence interval at 95 %) between IOS and BTS for all data combined was 0.962 (0.942-0.973), showing excellent reliability. Subset analyses showed that NCCLs with lower volume loss (early- and moderate-stage lesions) resulted in moderate ICCs, whereas severe lesions showed excellent ICC. Bland-Altman plots demonstrated general good agreement, with narrower limits for early stage-lesions., Conclusion: IOS data demonstrated good agreement to BTS, when measuring tooth structure loss in simulated NCCLs, with particularly higher ICC in more severe lesions. Considering the accessibility and ease-of-use, IOS showed to be a good alternative for the objective assessment of NCCLs in vitro., Clinical Significance: 3D intraoral scanners' accessibility and objectivity make them potentially valuable tools for assessing and monitoring NCCLs., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: co-author serves as an Associate Editor for the Journal of Dentistry and was not involved in the editorial review or the decision to publish this article. - Saoirse O'Toole. Other authors, they 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. Published by Elsevier Ltd.)

Objective: To investigate the effect of toothbrush head configuration and dentifrice slurry abrasivity on the development of simulated non-carious cervical lesions (NCCLs) in vitro., Methods: Extracted premolars were randomly allocated into 15 groups (n = 16) generated by the association between toothbrush head configuration (flat-trimmed, rippled, cross-angled/multilevel/rubbers added, cross-angled/multilevel/flex head, feathered) and dentifrice slurry abrasivity (low/medium/high). Teeth were mounted on acrylic blocks and had their roots partially covered with acrylic resin, leaving 2-mm root surfaces exposed. Toothbrushing was performed for 35,000 and 65,000 double-strokes. Specimens were analyzed using non-contact profilometry for dental volume loss (mm 3 ) and lesion morphology. Data was analyzed using ANOVA with pairwise comparisons and Kruskal-Wallis tests., Results: The two-way interaction between toothbrush head configuration and slurry abrasivity was significant (p = 0.02). At 35,000 strokes, the flat-trimmed and cross-angled/multilevel/rubbers added toothbrushes caused the highest loss, when associated to the high-abrasive slurry (p<0.05); whereas cross-angled/multilevel/flex head showed the least loss, when associated to the low-abrasive (p<0.05). At 65,000, more dental loss was observed for all toothbrushes when associated to the high-abrasive slurry, with flat-trimmed causing the highest loss (p < 0.05). Lower dental loss rates were observed for cross-angled/multilevel/flex head associated to the low-abrasive slurry when compared to the other toothbrushes (p < 0.05), except to feathered (p = 0.14) and rippled (p = 0.08). Flat lesions (mean internal angle ± standard-deviation: 146.2°± 16.8) were mainly associated with low-abrasive slurry, while wedge-shaped lesions (85.8°± 18.8) were more frequent with medium- and high-abrasive slurries., Conclusion: The development, progression and morphology of simulated NCCLs were modulated by both toothbrush head configuration and dentifrice abrasivity., Clinical Significance: Dental professionals should consider both the type of toothbrush and dentifrice abrasivity in the management plan of patients at risk of developing NCCLs., Competing Interests: Declaration of Competing Interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Wearable insulin biosensors represent a novel approach that combines the benefits of real-time glucose monitoring and automated insulin delivery, potentially revolutionizing how individuals with diabetes manage their condition., Study Purpose: To analyze the behavioral intentions of wearable insulin biosensors among diabetes patients, the factors that drive or hinder their usage, and the implications for diabetes management and healthcare outcomes., Methods: A cross-sectional survey design was adopted in this study. The validated questionnaire included 10 factors (Performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, trust, perceived privacy risk, and personal innovativeness) affecting the acceptance of wearable insulin sensors. A total of 248 diabetic patients who had used wearable sensors participated in the study., Results: Performance expectancy was rated the highest (Mean = 3.84 out of 5), followed by effort expectancy (Mean = 3.78 out of 5), and trust (Mean = 3.53 out of 5). Statistically significant differences (p < 0.05) were observed with respect to socio-demographic variables including age and gender on various influencing factors and adoption intentions. PE, EE, and trust were positively associated with adoption intentions., Conclusion: While wearable insulin sensors are positively perceived with respect to diabetes management, issues like privacy and security may affect their adoption., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alanzi et al.)

Introduction The integration of technology in pharmacy education has led to significant changes, making it essential to examine its impact on student learning outcomes. With the rise of emerging technologies, such as game-based learning and augmented reality, new pedagogical approaches have been introduced. However, these technologies also bring challenges that necessitate well-thought-out responses from educational institutions, especially considering the effects of the COVID-19 pandemic on learning formats. Methods A cross-sectional study was conducted with pharmacy students in the Kingdom of Saudi Arabia, utilizing stratified random sampling for data collection. The study employed a validated questionnaire to gather information on students' use of technology, their preferences, and their perceived learning outcomes. The analysis was carried out using Statistical Product and Service Solutions (SPSS, version 29) (IBM SPSS Statistics for Windows, Armonk, NY), ensuring adherence to the ethical standards set by the institutional review board. Results The study, involving 508 pharmacy students from Saudi Arabia, revealed that a significant majority regularly use technology in their education, particularly online learning management systems and virtual labs, indicating a shift toward more accessible and efficient learning methods. A notable portion of the students acknowledged the beneficial impact of technology on their learning, with 86.3% reporting improved knowledge retention, 92% noting enhanced skills, and 87.1% observing better academic performance. However, the study also uncovered challenges, with about half of the students facing issues mainly related to distractions while finding technological complexity less problematic. The support from educational institutions in addressing these issues was found to be moderate. These findings underscore the crucial role of technology in enhancing pharmacy education while highlighting the need for more comprehensive institutional support and strategic planning to address the challenges faced by students. Conclusions Technology plays a vital role in the modernization of pharmacy education, significantly aiding in knowledge retention, skill development, and academic performance. Despite the widespread use of technology, the varied experiences and challenges encountered by students underscore the need for increased institutional support and strategic planning. Education must adapt alongside technological advancements to cater to the diverse needs of learners, highlighting the importance of further research into the long-term effects and optimal strategies for technology integration in pharmacy education., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alhur et al.)

Background: Artificial intelligence (AI) is a novel technology that has been widely acknowledged for its potential to improve the processes' efficiency across industries. However, its barriers and facilitators in healthcare are not completely understood due to its novel nature., Study Purpose: The purpose of this study is to explore the intricate landscape of AI use in family medicine, aiming to uncover the factors that either hinder or enable its successful adoption., Methods: A cross-sectional survey design is adopted in this study. The questionnaire included 10 factors (performance expectancy, effort expectancy, social influence, facilitating conditions, behavioral intention, trust, perceived privacy risk, personal innovativeness, ethical concerns, and facilitators) affecting the acceptance of AI. A total of 157 family physicians participated in the online survey., Results: Effort expectancy (μ = 3.85) and facilitating conditions (μ = 3.77) were identified to be strong influence factors. Access to data (μ = 4.33), increased computing power (μ = 3.92), and telemedicine (μ = 3.78) were identified as major facilitators; regulatory support (μ = 2.29) and interoperability standards (μ = 2.71) were identified as barriers along with privacy and ethical concerns. Younger individuals tend to have more positive attitudes and expectations toward AI-enabled assistants compared to older participants (p < .05). Perceived privacy risk is negatively correlated with all factors., Conclusion: Although there are various barriers and concerns regarding the use of AI in healthcare, the preference for AI use in healthcare, especially family medicine, is increasing., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alanzi et al.)

Background: There is a strong association between emotional intelligence (EI) and academic performance in medical students., Objective: This study aimed to explore the ‏ relationship between EI and academic performance among medical students at Tabuk University., Methods: This cross-sectional study was conducted among medical students in clinical years in the Faculty of Medicine, Tabuk University, Tabuk City, Kingdom of Saudi Arabia (KSA). Each study participant received a self-administered questionnaire composed of two parts: demographic data and the Schutte Self Report Emotional Intelligence Test (SSEIT)., Results: The present study included 203 of the clinical-phase medical students. The academic achievement level was not associated with the students' gender (p = 0.194) or academic level (p = 0.278). Female students had a significantly higher total SSEIT score than male students (p < 0.001). The sixth-year students had a significantly higher perception of emotion than the fourth-year students (p = 0.029). Students with excellent academic achievement had higher mean scores for managing others' emotions (p = 0.004) and utilization of emotion compared to those with fair and very good levels (p = 0.042)., Conclusions: Some components of EI correlate with academic performance, gender, and academic level. Further research should be launched to assess the correlation between EI and academic performance among all medical students in all regions of KSA. Students can benefit by attending workshops and courses in universities to develop the students' EI because of its impact on their academic performance., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. University of Tabuk Research Ethics Committee issued approval UT-269-116-2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2023, El Seifi et al.)

Introduction and Importance: Transverse Testicular Ectopia (TTE) is characterized by the presence of testis in the hemiscrotum, which can be associated with a broad spectrum of complications. It is usually manifested in pediatrics. However, on rare occasions, it can occur in adults. The diagnosis is confirmed by magnetic resonance imaging (MRI). We present two cases of Transverse Testicular Ectopia (TTE), demonstrating the significance of early diagnosis and treatment to reach optimal outcomes., Case Presentation: We reported two patients with common features suggestive of Transverse Testicular Ectopia (TTE). Case 1 had open surgery; his left testis was impalpable, whereas his right side was palpable. Case 2 had undergone laparoscopy surgery, and his right and left spermatic cord was discovered on the right side., Clinical Discussion: Transverse Testicular Ectopia (TTE) is classified according to clinical presentation; Type 1 is associated with inguinal hernia ranging between 40 and 50 %. Type 2 is related to persistent mullerian duct syndrome (PMDS), with a rate of 30 %. Type 3 is associated with genital anomalies and azoospermia, with a rate of 20 %. The pathogenesis is unclear. However, studies suggest that the persistence of the mullerian duct prevents normal descent of the testis. Treatment is purely dependent on early clinical presentation and surgical methods., Conclusion: Transverse Testicular Ectopia (TTE) requires delicate care by the pediatric surgeon as it is considered a rare entity in such cases. Heroin, we highlight the significance of early surgical treatment and the possibility of complications if left untreated., Competing Interests: Conflict of interest statement 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 © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Food allergy is a serious and potentially life-threatening medical condition that affects both adults and children. School teachers are considered to be among the first line of defense in identifying and responding to such situations, as 22% of food allergic reactions occur in schools. It is, therefore, important to understand the knowledge and attitudes of school teachers toward food allergy. This study is a descriptive, cross-sectional investigation conducted using an online questionnaire from December 2022 to February 2023. We collected data from 413 primary school teachers in Makkah region, Saudi Arabia. SPSS version 21 (IBM Corp., Armonk, NY) was used to analyze the data. Out of 413 teachers who met the inclusion criteria, only 14.5% demonstrated good awareness levels (scoring above 60% on the knowledge questionnaire) regarding food allergy, with young teachers making up the highest proportion as 26.1% of younger teachers had good awareness levels compared to 8.8% of teachers aged 51-60 years (p = 0.012). Additionally, 46.7% of the teachers knew the symptoms of a severe allergic reaction, and only 16.7% knew that they should use an epinephrine pen as the first step in managing a severe allergic reaction. School teachers have insufficient knowledge about food allergies, underscoring the importance of establishing school policies to handle food allergies. Such policies should encompass the adoption of a comprehensive food allergy action plan, training programs for school personnel, and educational campaigns., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alzahrani et al.)

Introduction: The influenza virus produces everything from seasonal epidemics to unexpected pandemics, making its prevention and management a worldwide public health challenge. The main method to prevent and control seasonal influenza is vaccination. Children responded quite successfully to influenza vaccinations, particularly live vaccines. Despite the strong recommendations and effectiveness of seasonal influenza vaccinations in children, some parents still hesitate and refuse to give their children the shot., Objective: This study, given the importance of knowing the factors that contribute to parents' refusal of influenza vaccine, also aims to assess parental barriers and willingness to vaccinate their children in the Makkah region of Saudi Arabia., Methodology: This is a descriptive cross-sectional study conducted among Saudi parents in the Makkah region. For data collection, an online survey was conducted between December 1, 2022, and February 11, 2023., Results: In total, 334 of the parents participated in our study. The result shows that there is a significant association between parents' gender and receiving the flu vaccine, with significantly more females (52.4%). Regarding the willingness to get the vaccine, the majority of the parents reported that they will get the vaccine and vaccinate their children, and the most common barrier that prevents parents from vaccinating their children is that they do not need it because they are healthy (21.48%). Furthermore, there is a strong relationship between educational level and knowledge about seasonal influenza vaccination; the majority of parents at each level of education have poor knowledge regarding influenza vaccines. In addition, nearly all of our participants (96.7%) believed the information provided by the Saudi Ministry of Health as well as the advice of their physicians., Conclusion: This study highlights the need to increase awareness, educate the parents in the Makkah region about the importance of the influenza vaccine, and encourage them to vaccinate their children., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alharbi et al.)

Background: Tinnitus is defined as the subjective perception of sound in the absence of an external stimulus, and tinnitus disorder becomes relevant when it is associated with emotional distress, cognitive dysfunction, and/or autonomic arousal. Hearing loss is recognized as the main risk factor for the pathogenesis of tinnitus. However, clinical guidelines for tinnitus disorder provide little direction for those who have severe-to-profound hearing loss including those who are pre-lingually Deaf. The aim of this scoping review was to catalogue what is known from the existing literature regarding the experience and management of tinnitus in adults who have a severe-to-profound hearing loss., Summary: A scoping review was conducted following the Preferred Reporting Item for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Records were included if they reported an evaluation of tinnitus in adults who had severe-to-profound hearing loss. The online databases Ovid (MEDLINE, EMBASE and PsycINFO), CINAHL, ProQuest, Scopus, and Google Scholar were searched using the search terms 'tinnitus' (as a MESH term) and 'deaf' OR 'profound hearing loss. Thirty-five records met the inclusion criteria for this review and were cataloged according to three major themes: Impact of tinnitus in deaf adults; Primary treatment of tinnitus in deaf adults; and Cochlear implant studies where tinnitus was a secondary outcome. Tinnitus symptom severity was assessed before and after intervention using tinnitus validated questionnaires in 29 records, with six further records using other assessment tools to measure tinnitus severity. Participants using cochlear implants were included in 30 studies. Medication, repetitive transcranial magnetic stimulation (rTMS), electrical promontory stimulation, and behavioral self-control therapy were each reported in single records., Key Messages: This scoping review cataloged the experience, assessment, and treatment of tinnitus in adults who have severe-to-profound hearing loss. It is shown that there is very limited research reported in this field. Although this review included many records, most focused on the provision of cochlear implants for severe-to-profound hearing loss, with assessment and measurement of tinnitus as a baseline or secondary outcome. Largely missing in the literature are empirical studies that seek firstly to understand the nature of the experience of tinnitus by people with no or little residual access to external sound., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Alzahrani, Sereda, Chamouton, Haider, Dewey and Hoare.)

Background While many cancer patients survive long after diagnosis, one is bound to experience long-term and latent side effects as a result of the treatment. This experience results in a poor quality of life, morbidity, and mortality for cancer survivors. Understanding how to manage these side-effects is quite important and a key to cancer survivorship. Objective Given the importance of this area, the main objective of this study seeks to understand the risk factor associated with cancer survivorship. Methods A cross-sectional study was conducted among 154 cancer survivors from King Fahad General and Kind Abdul-Aziz hospitals. Descriptive and inferential statistics were used in analyzing the responses. Descriptive statistics were used in understanding the extent of the risk factors while inferential statistics were used to understand the cross-relationships. Results This study included 154 cancer survivors aged 18 and above at King Fahad Hospital and King Abdul-Aziz Hospital in Jeddah, Makkah Region, KSA. Thirty-one (20.1%) of the sample were males and 123 (79.9%) were females. Of all the survivors who screened, 111 (72.9%) symptoms occur before treatment, 116 (75.3%) within the treatment, and 57 (37.09%) after treatment. The relationship between Socioeconomic Status Cross Symptoms categories demonstrated below includes accommodation type, education level, age, gender, and job. Conclusion The study concludes that post-cancer treatment symptoms are highly affected by other factors such as social-economic status as well as family support. As a result, the study recommends the establishment of educational materials on post-treatment symptoms, care-plans, and support groups for cancer survivors., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Hajjay et al.)

COVID-19 has impacted educational processes in most countries: some educational institutions have closed, while others, particularly in higher education, have converted to online learning systems, due to the advantages offered by information technologies. This study analyzes the critical factors influencing students' satisfaction with their continuing use of online learning management systems in higher education during the COVID-19 pandemic. Through the integration of social cognitive theory, expectation confirmation theory, and DeLone and McLean's IS success model, a survey was conducted of 181 UK students who engaged with learning management systems. It was found that, during the pandemic, service quality did not influence students' satisfaction, although both information quality and self-efficacy had significant impacts on satisfaction. In addition, the results revealed that neither self-efficacy nor satisfaction impacted personal outcome expectations, although prior experience and social influence did. The findings have practical implications for education developers, policymakers, and practitioners seeking to develop effective strategies for and improve the use of learning management systems during the pandemic., (© The Author(s) 2021.)