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Abdulelah M Aldhahir,1 Heba M Bintalib,2,3 Rayan A Siraj,4 Jaber S Alqahtani,5 Omar A Alqarni,6 Abdullah A Alqarni,7 Hanin S Alghamdi,8 Mohammed M Alyami,9 Abdallah Y Naser,10 Alaa I Fatani,11 Hassan Alwafi11 1Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 2Department of Respiratory Care, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 3King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia; 4Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia; 5Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia; 6Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; 7Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Respiratory Therapy, King Fahad General Hospital, Jeddah, Saudi Arabia; 9Respiratory Therapy Department, Batterjee Medical College, Khamis Mushait, Saudi Arabia; 10Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan; 11Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi ArabiaCorrespondence: Abdulelah M Aldhahir, Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Saudi Arabia, Tel +966557775561, Email Aldhahir.abdulelah@hotmail.comBackground: Nomophobia has been highly prevalent among health discipline students. However, there is no available data on the prevalence of nomophobia among respiratory therapy (RT) students in Saudi Arabia.Methods: A cross-sectional survey using the nomophobia questionnaire (NMP-Q) was conducted and distributed using a convenience sample of RT students through an online platform (Survey Monkey) between September and November 2022.Results: Overall, 1428 RT students, with males accounting for 773 (54%), responded to the online survey. The prevalence of nomophobia among RT students was 97.3% (1390). The mean (±SD) of the total NMP-Q items scores was 62 (± 22), indicating a moderate level of nomophobia among the RT students. Female RT students had significantly higher nomophobia scores than male RT students (63 (47– 80) vs 59 (43– 75); p < 0.001)). Single RT students had significantly higher nomophobia scores than married RT students (62 (46– 78) vs 46 (37– 64); p < 0.001)). RT students who were living outside the family home had significantly higher nomophobia scores than RT students who were living with their family (66 (54– 78) vs 60 (44– 77); p = 0.001)). RT students with a GPA of 4.50 to 5.00 had the highest nomophobia score (63 (46– 79); p = 0.005)). RT students who were in their third year had the highest nomophobia score (66 (48– 80); p < 0.001)). RT students who reported no academic warnings had the highest nomophobia score (63 (48– 80); p < 0.001)). RT students who spent ≥ five hours studying per week had the highest nomophobia score (64 (51– 80); p < 0.001)).Conclusion: Nomophobia is common among RT students, with the majority experiencing a moderate level. Being female, single, living outside the family home, and having a higher academic performance were risk factors associated with higher nomophobia levels.Keywords: nomophobia, respiratory therapy, NMP-Q

Abdulghfoor Abdurabuh,1 Mahar Diana Hamid,1,2 Che Rosmani Che Hassan,1 Mohammad I Fatani3 1Department of Chemical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, 50603, Malaysia; 2Sustainable Process Engineering Centre (SPEC), Department of Chemical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, 50603, Malaysia; 3Department of Dermatology, Hera General Hospital, Makkah, 24227, Saudi ArabiaCorrespondence: Mahar Diana Hamid, Sustainable Process Engineering Centre (SPEC), Department of Chemical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, 50603, Malaysia, Email mahar.diana@um.edu.myBackground: The impact of hospital accreditation on the organizational safety culture among healthcare workers, an essential indicator of patient safety, has yet to be directly quantified in Saudi Arabia’s healthcare system. This study aims to investigate this impact to sustain and maintain a positive safety culture in Saudi Arabia’s healthcare institutions.Methods: A cross-sectional assessment was conducted in five public hospitals in Makkah. Three hundred forty healthcare workers participated using a self-administered questionnaire. Data were analyzed using descriptive statistics, ANOVA, one-sample t-test, and multiple regression for a comprehensive understanding.Results and Discussion: Regression analysis revealed significant gender differences in patient safety ratings (B = 0.480, p < 0.001). Age positively influenced scores, with higher ages resulting in higher scores (B = 0.127, p = 0.041). The ratings were also associated with respondents’ nationality (B = 0.169, p < 0.001) and education levels (B = − 0.186, p < 0.001). Respondents rated disasters and training as the highest in patient safety culture, followed by facility safety and security, hazards and hazardous materials safety, utility and building safety, fire safety, and quality improvement. At the same time, leadership, commitment, and support received the lowest score.Conclusion: This study illustrates a strong connection between accreditation and improved patient safety, emphasizing the importance of quality improvement and leadership commitment. These insights can guide policymakers and healthcare executives in Saudi Arabia and similar countries toward developing a robust patient safety culture. It stresses the importance of considering human factors and organizational culture when developing patient safety models.Keywords: healthcare professionals, quality of healthcare, accreditation, facility management and safety, CBAHI

Abdulrahman K Al Asmari,1 Zabih Ullah,1 Mohammad Tariq,1 Amal Fatani21Department of Research, Prince Sultan, Military Medical City, 2Department of Pharmacy, King Saud University, Riyadh, Saudi ArabiaAbstract: The adequate amount of drug delivery to the brain in neurological patients is a major problem faced by the physicians. Recent studies suggested that intranasal administration of liposomal formulation may improve the drug delivery to the brain. In the present study, an attempt was made to study the brain bioavailability of commonly used anti-Alzheimer drug donepezil (DNP) liposomal formulation by intranasal route in rats. We adopted the thin layer hydration technique for the preparation of liposomes by using cholesterol, polyethylene glycol, and 1,2-distearyl-sn-glycero-3-phosphocholine (DSPC). The prepared liposomes were characterized by determining particle size, shape, surface morphology, zeta potential, encapsulation efficiency, and in vitro release of DNP. The pharmacokinetic parameters of liposomal DNP in plasma and brain of rats were determined following oral and nasal administration. The results of this study showed that the DNP liposomal formulation was stable with a consistent size (102±3.3 nm) and shape. The prepared liposomes showed high encapsulation efficiency (84.91%±3.31%) and sustained-release behavior. The bioavailability of DNP in plasma and brain increased significantly (P

Abstract Background Infective endocarditis is an infection of microbial origin affecting the endocardial layer of the heart, mostly impacting the heart valves. Right-sided infective endocarditis mainly affects the tricuspid valve. In some cases where surgical management is indicated the patients might not be good candidates for surgery. The AngioVac drainage cannula (AngioDynamics, Latham, NY, USA) is a novel device used in debulking and suction of intravascular material. It has been reported in the literature as a novel treatment for patients with right-sided tricuspid valve endocarditis vegetations, where their size is reduced and the efficacy of antibiotics in clearing the bloodstream infection is enhanced. Methods and results We conducted a thorough literature review to assess the uses of the AngioVac drainage cannula in the management of right-sided infective endocarditis vegetations and lesions. We collected all reported cases where the system was used for the management of right-sided infective endocarditis and performed an encompassing review of the literature. In the review, we found 65 cases reported using the AngioVac drainage cannula for the removal of right-sided infective endocarditis vegetations. Majority of the cases were successful with no complications (87.6%); 7 (10.7%) cases were successful but there were complications: 2 reported mortalities, 1 patient had worsening TR during follow-up, 3 had recurrence of the vegetation, and 1 patient remained bacteremic. There was only 1 reported failure. Four (6.1%) patients required postprocedural valvular surgery with 3 repairs and a single valve replacement. Conclusions The AngioVac system is a possible bailout option for surgeons managing patients with right-sided infective endocarditis vegetations who are not ideal candidates for surgery. With increased reports on its use, it could be effective at reducing the microbiological burden with minimal complications.

Abstract Background Arterial tortuosity syndrome is a rare Autosomal recessive disease that leads to a loss of function of the connective tissues of the body, this happens due to a mutation in the solute carrier family 2 member 10 (SLC2A10) gene. ATS is more likely to occur in Large and medium-sized arteries including the aorta and pulmonary arteries. This syndrome causes the arteries to be elongated and tortuous, This tortuosity disturbs the blood circulation resulting in stenosis and lack of blood flow to organs and this chronic turbulent flow increases the risk of aneurysm development, dissection and ischemic events. Case presentation A 2 years old Arabian female child was diagnosed with ATS affecting the pulmonary arteries as a newborn, underwent a pulmonary arterial surgical reconstruction at the age of 2 years old due to the development of pulmonary artery stenosis with left pulmonary artery having a peak gradient of 73 mmHg with a peak velocity of 4.3 m/s and the right pulmonary artery having a peak gradient of 46 mmHg with a peak velocity of 3.4 m/s causing right ventricular hypertension. After surgical repair the left pulmonary artery has a peak pressure gradient of 20 mmHg, with the right pulmonary artery having a peak pressure gradient of 20 mmHg. Conclusion ATS is a rare genetic condition that affects the great arteries especially the pulmonary arteries causing stenotic and tortuous vessels that may be central branches or distal peripheral branches that leads to severe right ventricular dysfunction and hypertension. We believe that surgical treatment provides the optimum outcomes when compared to transcather approaches especially when the peripheral arteries are involved. Some challenges and hiccups might occur, especially lung reperfusion injury that needs to be diagnosed and treated accordingly.

Enterococcus faecalis is considered a probiotic, commensal lactic acid bacterium in human breast milk (HBM), but there are circulating antibiotic resistant and virulence determinants that could pose a risk in some strains. The study aimed to conduct genomic analysis of E. faecalis isolates recovered from HBM and animal milk and to evaluate their probiotic and pathogenic features through comparative genomics with isolates from clinical specimens (e.g., urine, wound, and blood). Genomic analysis of 61 isolates was performed, including E. faecalis isolates recovered from HBM in Saudi Arabia. Genome sequencing was conducted using the MiSeq system. The fewest antibiotic resistance genes (lsaA, tetM, ermB) were identified in isolates from HBM and animal milk compared to clinical isolates. Several known and unknown mutations in the gyrA and parC genes were observed in clinical isolates. However, 11 virulence genes were commonly found in more than 95% of isolates, and 13 virulence genes were consistently present in the HBM isolates. Phylogenetically, the HBM isolates from China clustered with the probiotic reference strain Symbioflor 1, but all isolates from HBM and animal milk clustered separately from the clinical reference strain V583. Subsystem functions 188 of 263 were common in all analyzed genome assemblies. Regardless of the source of isolation, genes associated with carbohydrate metabolism, fatty acid, and vitamin biosynthesis were commonly found in E. faecalis isolates. In conclusion, comparative genomic analysis can help distinguish the probiotic or pathogenic potential of E. faecalis based on genomic features.

IntroductionThe prevalence of diet-related non-communicable diseases has increased. A low-carbohydrate diet (LCDs) is one of the most popular interventions. Several systematic reviews and meta-analyses of randomised clinical trials (RCTs) and non-RCTs have linked LCDs to the management of obesity, diabetes, cardiovascular disease, epilepsy, and cancer. However, there has been limited appraisal of the strength and quality of this evidence.ObjectiveTo systematically appraise existing meta-analyses and systematic reviews of RCTs and non-RCTs on the effects of LCDs on different health conditions. To understand their potential efficacy, we summarised the studies' findings and assessed the strength of the evidence.MethodsA search was conducted using the PubMed database from inception to October 2021 for systematic reviews and meta-analyses of RCTs and non-RCTs investigating the association between LCDs and multiple health outcomes in humans. The Academy of Nutrition and Dietetics Quality Criteria was used for the quality assessment. In addition, the evolution of heterogeneity, strength of the included studies, and effect sizes were extracted from each systematic review and meta-analysis.ResultsTen systematic reviews and meta-analyses were included. Of the included reviews, 70% were of positive quality, 30% were neutral, and none were negative. The majority of the studies included strength in each systematic review, and the meta-analyses were of low to medium strength. The existing literature indicates that LCDs may help promote weight reduction in adults who are obese or overweight. This conclusion is supported by the findings of studies included in the analysis, which were of low to moderate strength. Furthermore, compelling data indicates a significant association between low-carbohydrate diets (LCDs) and a reduction in haemoglobin A1c levels among those diagnosed with type 2 diabetes mellitus. In contrast, there was a lack of evidence of this correlation in type 1 diabetes mellitus patients or those with cardiovascular diseases. Additionally, there was limited evidence regarding the effectiveness of LCDs in epilepsy and adult cancer patients.ConclusionThis review thoroughly examines the current body of information on how LCDs affect various health outcomes. Studies have presented evidence to support the idea that incorporating LCDs can positively influence weight management and HbA1c levels. However, there is a lack of information regarding the association between LCDs and individuals with Type 1 diabetes mellitus and cardiovascular diseases. Additionally, there is limited empirical evidence to substantiate the effectiveness of LCDs in the treatment of epilepsy and adult cancer patients. The long-term effects of LCDs on mortality and other chronic diseases that account for different carbohydrate subtypes is unclear. Further longitudinal cohort studies are required to reach definitive conclusions.

OBJECTIVES:. Anemia has been associated with an increased risk of both cardiac arrest and stroke, frequent complications of COVID-19. The effect of hemoglobin level at ICU admission on a composite outcome of cardiac arrest or stroke in an international cohort of COVID-19 patients was investigated. DESIGN:. Retrospective analysis of prospectively collected database. SETTING:. A registry of COVID-19 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with cardiac arrest or stroke up to 30 days after ICU admission. Anemia was defined as: normal (hemoglobin ≥ 12.0 g/dL for women, ≥ 13.5 g/dL for men), mild (hemoglobin 10.0–11.9 g/dL for women, 10.0–13.4 g/dL for men), moderate (hemoglobin ≥ 8.0 and < 10.0 g/dL for women and men), and severe (hemoglobin < 8.0 g/dL for women and men). PATIENTS:. Patients older than 18 years with acute COVID-19 infection in the ICU. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Of 6926 patients (median age = 59 yr, male = 65%), 760 patients (11.0%) experienced stroke (2.0%) and/or cardiac arrest (9.4%). Cardiac arrest or stroke was more common in patients with low hemoglobin, occurring in 12.8% of patients with normal hemoglobin, 13.3% of patients with mild anemia, and 16.7% of patients with moderate/severe anemia. Time to stroke or cardiac arrest by anemia status was analyzed using Cox proportional hazards regression with death as a competing risk. Covariates selected through clinical knowledge were age, sex, comorbidities (diabetes, hypertension, obesity, and cardiac or neurologic conditions), pandemic era, country income, mechanical ventilation, and extracorporeal membrane oxygenation. Moderate/severe anemia was associated with a higher risk of cardiac arrest or stroke (hazard ratio, 1.32; 95% CI, 1.05–1.67). CONCLUSIONS:. In an international registry of ICU patients with COVID-19, moderate/severe anemia was associated with increased hazard of cardiac arrest or stroke.

Salem Bahashwan,1,2 Rahaf Mohammad Almuhanna,3 Maryam Taher Al Hazza,1 Reem Wajdi Baarma,1 Abdulrahman Yousif AlNajjar,4 Faris Sameer Siddiqui,1 Shouq Ziyad Fatani,5 Ahmed Barefah,1,2 Hatem Alahwal,1,2 Abdullah Almohammadi,1,2 Osman Radhwi,1,2 Alaa S Algazzar,6 Eman M Mansory1,2 1Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 2Hematology Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 3Emergency Medicine Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 4Emergency Medicine Department, King Abdullah Medical Complex, Jeddah, Saudi Arab; 5Physical Medicine and Rehabilitation, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 6Cardiology Department,Ahmed Maher Teaching hospital, Cairo, EgyptCorrespondence: Salem Bahashwan, Hematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi Arabia, Tel +966555511968, Email smbahashwan1@kau.edu.saBackground: Sickle cell disease is an inherited blood disorder which can lead to severe complications, particularly in the cardiovascular and respiratory systems, potentially resulting in arrhythmias, pulmonary hypertension (PH), and cardiomegaly. This study aims to investigate the risk of PH and arrhythmias in adult SCD patients.Methods: Retrospective analysis of medical records from King Abdulaziz University Hospital (KAUH) for patients with SCD aged 15 and above between 2009 and 2021. The study included 517 patients, with echocardiograms and electrocardiograms assessed according to the European Society of Cardiology/the European Respiratory Society (ESC/ERS) guidelines for categorizing PH risk (low, moderate, high) and detecting arrhythmias. Data analysis employed the Statistical Package for the Social Sciences (SPSS), utilizing quantitative and qualitative data representation. Multivariate logistic regression identified independent risk factors with odds ratios at a 95% confidence interval (CI).Results: Among participants, 50.3% were male, with a total sample average age of 34.45 ± 9.28 years. Results indicated that 1.4% of patients experienced arrhythmias, 3.7% had a moderate PH risk, and 3.3% were classified as high PH risk. Logistic regression revealed significant independent risk factors for PH and arrhythmia in patients with SCD, with chronic kidney disease (CKD) carrying the highest odds (26.4 times higher odds of PH and 15.36 times higher odds of arrhythmias).Conclusion: Patients with SCD are at risk for developing PH and various arrhythmias but are often underdiagnosed. Key risk factors for PH included CKD, liver cirrhosis, and pre-existing cardiac conditions. Arrhythmias were significantly associated with CKD and pre-existing cardiac conditions. To mitigate these risks, we recommend involving a multidisciplinary healthcare team in the care of adult patients with SCD. Future prospective studies are advised for early detection of PH and arrhythmias in hemoglobinopathy patients, potentially reducing mortality. Keywords: sickle cell disease, arrhythmia, pulmonary hypertension, chronic kidney disease, hemoglobinopathies, PH risk

Ghassan J Alboloshi,1 Asif A Jiman-Fatani,2,3 Dalya Attallah,3 Jawahir A Mokhtar,2– 4 Nabeela Abdullah Al-Abdullah,5,6 Khalil Alkuwaity,4,7 Reham Kaki,6,8 Mohammed W Al-Rabia,2 Abdelbagi Alfadil,2,9 Karem Ibrahem,2 Addisu D Teklemariam,10,11 Steve Harakeh12,13 1Department of Medical Laboratories, King Abdullah Medical Complex Jeddah, Ministry of Health, Jeddah, Saudi Arabia; 2Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Clinical and Molecular Microbiology Laboratory, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 4Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Public Health, College of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia; 6Department of Infection Control and Environmental Health, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 7Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 9Center of Research Excellence for Drug Research and Pharmaceutical Industries, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; 10Department of Biological Sciences, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia; 11Department of MIVP, College of Veterinary Medicine and Agriculture, Addis Ababa University, Addis Ababa, Ethiopia; 12King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 13Yousef Abdul Latif Jameel Scientific Chair of Prophetic Medicine Application, Faculty of Medicine, King Abdulaziz University, Jeddah, 21589, Saudi ArabiaCorrespondence: Abdelbagi Alfadil, Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, P.O. Box 80205, King Abdulaziz University, 21589, Saudi Arabia, Tel +96612 6952000 Ext 21062, Email aegmusa@kau.edu.saBackground: Fungal infections, especially those caused have emerged as a significant medical concern over the past three decades, particularly among immunocompromised patients. However, recent studies have highlighted the increasing prevalence of fungal infections resembling yeast other than Candida, such as trichosporonosis, especially among immunosuppressed individuals worldwide. Trichosporon has been identified as a significant contributor to superficial and invasive infections. Invasive trichosporonosis, primarily affecting immunocompromised patients, poses a significant threat with high mortality rates.Purpose: The current study aimed to explore the clinical epidemiology of Trichosporon spp at King Abdulaziz University Hospital (KAUH) in Saudi Arabia.Methods: This retrospective study aimed to assess the clinical epidemiology of Trichosporon spp. infections in microbiology cultures obtained from KAUH in Saudi Arabia. The study analyzed data from patients over a five-year period, focusing on demographic, clinical, and microbiological characteristics.Results: This study encompassed 21 participants, categorized into four distinct age groups. Moreover, this study indicated T. asahii as the predominant species isolated, accounting for 90.5% of infections, followed by T. mucoides (9.5%). ICU hospitalization, diabetes mellitus, taking immunosuppressive drugs, and antifungal drugs, and the use of invasive medical equipment were identified as prominent risk factors for trichosporonosis. Urinary tract infections were the most common clinical presentation, particularly among male and elderly patients. Mortality rates were high, especially among older individuals.Conclusion: This study contributes valuable epidemiological insights into trichosporonosis, highlighting the need for enhanced surveillance and preventive strategies in healthcare settings. Further research is warranted to optimize treatment approaches and infection control measures, ultimately reducing the burden of Trichosporon infections on patient outcomes.Keywords: fungal infection, trichosporonosis, Trichosporon spp, Trichosporon asahii, invasive, risk factors

Abstract Background The “C group” of the histiocytic disorders is characterized by non-Langerhans-cell histiocytic lesions in the skin, mucosal surfaces, or both, out of which Juvenile xanthogranuloma (JXG) is the most common typically affecting the skin. The eye is the most common extra-cutaneous site of JXG., we aim at providing our clinical and histopathological experience with this group of diseases including the adult-onset xanthogranuloma (AXG). Methods This is a retrospective cohort study of all patients with the tissue diagnosis of ocular and periocular cutaneous and mucocutaneous non-LCH disorders who presented to us over a period of 25 years (January 1993 to December 2018). Results Twenty patients were diagnosed as “Group C” disease with an age range of 2 months-60.9 years. Eleven patients were females (55%) and nine were males (45%). The involvement was mostly unilateral in 80.9%. All cases fell into the xanthogranuloma family with 11 JXG patients, 8 AXG patients of skin and ocular surface, and one patient with solitary reticulohistiocytoma (SRH). The clinical site of involvement in JXG was primarily in the eyelid in 5 patients (45%), ocular surface lesions in 2 (18%), iris in 2 (18%), choroidal and bilateral orbital lesions in 1 patient each (9%). The group of AXG, presented equally with eyelid lesions in 4/8 and ocular surface lesions in 4/8. The non-Langerhans’ histiocytic infiltrate showed supportive immunohistochemical staining properties (reactive to CD68 marker and negative to S-100 and langerin markers). Conclusion Among the rare histiocytic disorders, xanthogranulomatosis is the commonest and has wide clinical manifestations. Accurate diagnosis needs to be supported by typical histopathological findings. JXG was the commonest in our study with relatively older mean age at presentation and frequent eyelid rather than iris involvement. AXG is often confused with xanthelasma when involving the eyelids with corneal limbal involvement is relatively frequent.

Aim: This study aims to identify and address the predictors that promote or prevent the utilization of dental services in primary health care (PHC) centers located in Riyadh, Saudi Arabia, with an ultimate goal to increase the uptake of oral health care (OHC) services. Methodology: Registration data from 99 PHC centers was used. For each patient visiting a PHC center, information on the number of dental visits was captured. Continuous data was summarized as means, medians, and ranges, and categorical data as frequencies (%). The strength of association was reported as an incidence rate ratio (IRR) with 95% confidence interval (CI) and a p-value. Further analysis was conducted to illustrate the association between dental care visits and factors found independently significant in the final multivariate model using Karl Pearson correlation coefficient and t-test. All tests were two-sided and a p-value of p

Purpose: There is limited information about the diagnosis and treatment of hidradenitis suppurativa (HS) in the Kingdom of Saudi Arabia (KSA). This Delphi consensus study was conducted to develop recommendations for the management of HS in the KSA.Methods: The expert panel including 12 dermatologists with extensive experience treating HS patients provided nine consensus statements and recommendations on diagnosis and assessment, management, comorbidities and multidisciplinary approach, and education. The experts also developed clinical questions pertaining to the management of HS and rolled out as a survey to 119 dermatologists practising in the KSA.Results: The topics covered included: referring physicians’ awareness of HS; referral criteria for HS; definition of moderate-to-severe HS; treatment goals; definition of treatment success; treatment and biologic initiation; comorbidities and multidisciplinary approach; patient education and awareness of HS. Full consensus (100%) from the expert dermatologists was received on all the topics except referring physicians’ awareness of HS, definition of treatment success, and treatment and biologic initiation. The survey results resonated with the expert opinion.Conclusion: As HS is a chronic disease with negative impact on quality-of-life, timely diagnosis and treatment, early identification of comorbid conditions and a multidisciplinary care approach are crucial for effective management of HS.

Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.

Background: The kidneys carry out many essential processes. A reduced glomerular filtration rate is the primary cause of renal failure. Patients with chronic kidney disease are significantly increasing all around the world. Patients with varying degrees of renal disease will be seen on the dental chair, and the dentist must be aware of dental considerations when treating such patient. Dental clinicians should carefully evaluate the oral findings and general condition of the renal disease patient. Objective: To increase the awareness of dentists in the dental management of patients with renal diseases or undergoing renal transplant. Methods: This study reviews 56 articles searched on two databases PubMed and Google Scholar with English language. Conclusion: Every dentist should be well-informed regarding dental considerations and oral manifestations when treating a patient with any renal disease. Simple treatment plan modification can prevent the evolution of mild to critical medical or dental complications in renal disease patients.

Mohammad I Fatani,1 Ibrahim Al-homood,2 Mohamed Bedaiwi,3 Sahar Al Natour,4 Alper Erdogan,5 Aya Alsharafi,5 Suzan M Attar6 1Department of Dermatology, Heraa Hospital, Mecca, Makkah, Kingdom of Saudi Arabia; 2Department of Rheumatology, King Fahad Medical City (KFMC), Riyadh, Riyadh Province, Kingdom of Saudi Arabia; 3Department of Rheumatology, King Saud University, Riyadh, Riyadh Province, Kingdom of Saudi Arabia; 4Department of Dermatology, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Kingdom of Saudi Arabia; 5Eli Lilly and Company, Riyadh, Riyadh Province, Kingdom of Saudi Arabia; 6Department of Internal Medicine, King Abdulaziz University, Jeddah, Makkah, Kingdom of Saudi ArabiaCorrespondence: Mohammad I Fatani, Department of Dermatology, Heraa Hospital, Al Madinah Al Munawarah Road, Mecca, Makkah, 24227, Kingdom of Saudi Arabia, Email m_fatani@yahoo.comPurpose: Psoriasis is a chronic, inflammatory, immune-mediated skin disease that has significant impact on a patient’s quality of life, yet it remains challenging for dermatologists to successfully identify and manage. Without effective screening, diagnosis and treatments, psoriasis can potentially progress to psoriatic arthritis. A descriptive, observational cross-sectional study of Saudi Arabian dermatologists and patients with psoriasis was conducted to explore dermatologist and patient perspectives of psoriasis, including diagnosis, management, disease course and unmet needs.Patients and Methods: This study involved a quantitative questionnaire administered to 31 dermatologists and 90 patients with psoriasis at eight medical centers and was analyzed using descriptive statistics.Results: Dermatologists and patients perceived that psoriasis treatment was initiated promptly and that follow-up visits were sufficient. Their perspectives differed in the time to diagnosis and patient reaction, symptom severity, input into treatment goals and educational needs. The dermatologists’ concerns about underdiagnosed psoriasis (13%) were primarily related to patient awareness (87%), physician awareness (58%), and the absence of a regular screening program (52%). Only 31% of patients with psoriasis were highly satisfied with their psoriasis treatment, with 78% experiencing unpleasant symptoms of pain or swelling in joints indicative of psoriatic arthritis. However, only 56% of these patients reported these symptoms to their physicians. When dermatologists were made aware of this difference, referrals to a rheumatologist increased.Conclusion: The study highlights the importance of strengthening psoriasis management by enhancing dermatologist referral and screening practices, adopting a multidisciplinary approach to care, and improving education and resources for physicians and patients. These results can help to inform the improvement of psoriasis screening, diagnosis and treatment strategies and ensure that expectations meet treatment outcomes. Further research exploring the dermatologist and patient perspectives of the disease pathway from psoriasis to psoriatic arthritis and tailor-made treatment approaches is recommended.Keywords: autoimmune disease, disease pathway, patient satisfaction, provider perspective

Purpose: Knowledge of the length of the colon is relevant to understanding physiological and pathological function. It also has implications for diagnostic and clinical interventions, as well as for the design of delayed-release drug formulations and drug disposition modeling. Methods: Over the years, a range of different experimental methods have been employed to assess colon length. These methods vary from direct measurements on cadavers and during intraoperative procedures to measurements obtained from endoscopic and medical imaging techniques. However, no systematic review or meta-analysis of these findings has yet been carried out. In this systematic review, we identified 31 published experimental studies that measured the length of the human colon and/or its segments. Results: We synthesized the available data, comprising colon length measurements from 5741 adults and 337 children and young people, in a meta-analysis. The data contribute to our understanding of colon morphology and may have implications for clinical practice, particularly for colonoscopy and preoperative planning of surgical resections. Additionally, this review provides potential insights into anatomical correlates of functional diseases, such as constipation. Conclusions: This review highlights that non-invasive, non-destructive diagnostic imaging techniques, such as magnetic resonance imaging (MRI), can provide more physiologically relevant measurements of colon length. However, there is a need for more standardized measurement protocols and for additional pediatric data.

Introduction Appropriate quality and quantity of sleep are critical for good mental health, optimal body functioning, memory consolidation, and other cognitive processes.

Key Clinical Message Mycotic pseudoaneurysms can be a serious and life threatening complication of left sided infective endocarditis. They most commonly affect the major axial vessels. Profunda femoris artery (PFA) aneurysms are rare and present in only 0.5% of all peripheral aneurysms, regardless of the underlying etiology. We present a case of a patient who underwent mitral valve repair for severe mitral regurgitation secondary to culture negative IE which was complicated by multiple mycotic pseudoaneurysm. The PFA pseudoaneurysm which was affected and was complicated with a large hematoma compressing the femoral nerve. This was managed by a staged hybrid approach. Endovascular stenting was performed first to seal the pseudoaneurysm and facilitate open surgical repair using a reversed interposition saphenous vein graft. To the best of our knowledge, this is the first reported case of a PFA mycotic aneurysm (MA) being managed by a hybrid approach using endo‐vascular and open surgical repair. MAs and pseudoaneurysms are complex and life threatening conditions requiring meticulous planning for optimal management. Endovascular stenting can be considered as an alternative to surgical management in certain cases or as a bridge to definitive open surgical repair depending on anatomical location and associated complications.

Abstract Psoriasis is associated with various comorbidities with a notable psychosocial burden. This systematic literature review explores the burden of depression in patients with psoriasis, comparing it with that experienced by patients with other chronic medical conditions. Embase via Ovid, PubMed, and Cochrane Database of Systematic Reviews via Ovid were searched for peer-reviewed studies published in English between January 1, 2016 and December 6, 2021 that reported real-world evidence or observational studies involving at least 100 adults (age ≥ 18 years) with general (unspecified) or plaque psoriasis experiencing symptoms of depression (but not restricted to patients with a clinical diagnosis). Any report of depression or suicidality was eligible for inclusion. Systematic literature reviews reporting depression/suicidality in other chronic medical conditions were also included. Statistical analysis was not performed; the study was descriptive only. A total of 1744 records were identified, and after several defined screenings by two independent reviewers for publication year, relevance, and sample size, 82 publications were included. Psoriasis was significantly associated with depression. The prevalence of depression in patients with psoriasis ranged from 0.2% to 74.6%, with incidence from 4.83 to 91.9 per 1000 person-years. The prevalence of depression was generally higher among patients with more severe psoriasis than those with less severe disease (as determined by Psoriasis Area Severity Index [PASI] scoring system) and was more prevalent among women than men with psoriasis. Depression in psoriasis significantly reduced quality of life, including factors such as sexual dysfunction, sleep difficulties, subjective well-being, and addictions. Comorbid hypertension, hyperlipidemia, psoriatic arthritis, obesity, inflammatory bowel disease, diabetes, and statin use were all associated with increased depression risk in patients with psoriasis. This systematic literature review found that the burden of depression in psoriasis is no lower than in other chronic medical conditions. Greater awareness of the psychological impact of psoriasis would improve care and management, which should incorporate psychological interventions.

Background/Objectives: Mental health conditions are a leading cause of morbidity and mortality worldwide, with a 13% rise within the last decade. This study aimed to investigate the factors associated with mental illness in patients presenting to a primary healthcare center in the Kingdom of Saudi Arabia (KSA). Methods: Data were extracted from the electronic health records of 46 primary care centers in Riyadh, Saudi Arabia from March 2022 to March 2023. A total of 2418 age-matched mental health cases and controls were evaluated. Descriptive and logistic regression analyses were performed to examine the distribution and association of relevant risk factors. A total of 1209 cases were age-matched to 1209 controls presenting to a primary clinic. Results: The odds of mental illness in females were 2.2 times that of males. Clinical conditions associated with mental illness were stroke, diabetes, and obesity. Neurodegenerative disorders were also associated with mental illness. Conclusions: Primary clinics in the KSA can serve as focal points in removing the barriers to mental healthcare. There is an urgent need to spread awareness, remove the stigma, and provide appropriate care and referrals for mental health conditions in the KSA.

Mesenchymal stem cells (MSCs) of placental origin hold great promise in tissue engineering and regenerative medicine for diseases affecting cartilage and bone. However, their utility has been limited by their tendency to undergo premature senescence and phenotypic drift into adipocytes. This study aimed to explore the potential involvement of a specific subset of aging and antiaging genes by measuring their expression prior to and following in vitro-induced differentiation of placental MSCs into chondrocytes and osteoblasts as opposed to adipocytes. The targeted genes of interest included the various LMNA/C transcript variants (lamin A, lamin C, and lamin A∆10), sirtuin 7 (SIRT7), and SM22α, along with the classic aging markers plasminogen activator inhibitor 1 (PAI-1), p53, and p16INK4a. MSCs were isolated from the decidua basalis of human term placentas, expanded, and then analyzed for phenotypic properties by flow cytometry and evaluated for colony-forming efficiency. The cells were then induced to differentiate in vitro into chondrocytes, osteocytes, and adipocytes following established protocols. The mRNA expression of the targeted genes was measured by RT-qPCR in the undifferentiated cells and those fully differentiated into the three cellular lineages. Compared to undifferentiated cells, the differentiated chondrocytes demonstrated decreased expression of SIRT7, along with decreased PAI-1, lamin A, and SM22α expression, but the expression of p16INK4a and p53 increased, suggesting their tendency to undergo premature senescence. Interestingly, the cells maintained the expression of lamin C, which indicates that it is the primary lamin variant influencing the mechanoelastic properties of the differentiated cells. Notably, the expression of all targeted genes did not differ from the undifferentiated cells following osteogenic differentiation. On the other hand, the differentiation of the cells into adipocytes was associated with decreased expression of lamin A and PAI-1. The distinct patterns of expression of aging and antiaging genes following in vitro-induced differentiation of MSCs into chondrocytes, osteocytes, and adipocytes potentially reflect specific roles for these genes during and following differentiation in the fully functional cells. Understanding these roles and the network of signaling molecules involved can open opportunities to improve the handling and utility of MSCs as cellular precursors for the treatment of cartilage and bone diseases.

Glioblastoma multiforme (GBM) is a fast-growing and aggressive brain tumour, which remains largely resistant to treatment; the prognosis for patients is poor, with a median survival time of about 12–18 months, post diagnosis. In an effort to bring more efficacious treatments to patients, we targeted the down regulation of ITCH, an E3 ligase that is overexpressed in a variety of cancers, and which inhibits P73, a tumour suppressor gene. 6-O-glycolchitosan (GC) was used to deliver siRNA ITCH (GC60-siRNA-ITCH) and gemcitabine via the nose to brain route in CD-1 nude mice which had previously been implanted intracranially with U87-MG-luc2 cells. Prior to this in vivo study, an in vitro study established the synergistic effect of siRNA-ITCH in combination with a chemotherapy drug—gemcitabine. A downregulation of ITCH, an upregulation of p73 and enhanced apoptosis were observed in vitro in U87-MG cells, using qPCR, Western blot analysis, confocal laser scanning microscopy, flow cytometry and cytotoxicity assays. When GC60-siRNA-ITCH was combined with gemcitabine, there was a resultant decrease in cell proliferation in vitro. In CD1 mice, the administration of siRNA-ITCH (7 doses of 0.081 mg/kg) alone did not significantly affect animal survival (increasing mean survival from 29 to 33 days when compared to untreated animals), whereas intranasal gemcitabine had a significant effect on survival (increasing survival from 29 to 45 days when compared to untreated animals, p < 0.01). The most significant effect was seen with combination therapy (GC60-siRNA-ITCH plus gemcitabine), where survival increased by 89%, increasing from 29 to 54 days (p < 0.01). Our data demonstrate that siRNA chemosensitises brain tumours to gemcitabine and that the nose-to-brain delivery route may be a viable route for the treatment of intracranial tumours.

Purpose/Background: Patients and healthcare providers use online health information and social media (SM) platforms to seek medical information. As the incidence of cancer rises, the popularity of SM platforms has yielded widespread dissemination of incorrect or misleading information about it. In this study, we aimed to assess public knowledge about incorrect cancer information and how they perceive such information in Saudi Arabia. Methods: A nationwide survey was distributed in Saudi Arabia. The survey included questions on demographics, SM platform usage, and common misleading and incorrect cancer information. Results: The sample (N = 3509, mean age 28.7 years) consisted of 70% females and 92.6% Saudi nationals. Most participants had no chronic illness. One-third were college graduates and less than one-quarter were unemployed. Conclusions: Differences in level of knowledge about cancer emerged in association with different demographic factors. Public trust in health information on SM also led to being misinformed about cancer, independent from educational level and other factors. Efforts should be made to rapidly correct this misinformation.

Apnea testing is a standard method when diagnosing brain or more specifically brainstem death; however, it is imperative to acknowledge the potential for lung injury during this procedure and follow clinical practice guideline recommendations that may reduce the risk of complications. Two cases of barotrauma leading to pneumothorax occurred during apnea tests that used higher-than-recommended oxygen flow rates. Additional data are necessary to clarify the mechanism and incidence of this life-threatening complication.

Background: Literature has reported differences in the epidemiology or natural history of non-communicable diseases among both the male and female sexes. Stratification of multimorbidity burden based on sex is crucial to identify and implement targeted prevention and control interventions for chronic diseases. Objectives: To determine the burden of hypertension, type-2 diabetes mellitus, and obesity; and to compare the related multimorbidity among male and female patients. Methods: The study was a retrospective analysis of 375 802 medical records from primary care centers. Data was extracted from March 2022 to March 2023. A multivariate probit estimation methodology was employed using a 3-equations multivariate multiple probit model to jointly estimate the association of a person’s sex with the diagnosis of the 3 chronic conditions: obesity, diabetes, and hypertension. A multinomial logistic regression analysis was conducted to allow each unique combination of these 3 chronic diseases. Results: Females had a relatively higher proportion of obesity (58.1% vs 41.2%), obesity and diabetes only (58.9% vs 41.1%), obesity and hypertension (63.6% vs 36.4%), and joint diagnosis with 3 conditions (65.7% vs 34.3%). Females’ participants consistently had a significantly higher likelihood of diagnosis compared with males except for diabetes (OR = 0.59, 95% CI: 0.56-0.62) and the combination of only diabetes and hypertension (OR = 0.67, 95% CI: 0.61-0.74). The likelihood of other combinations ranged from 1.04 (95% CI: 0.98-1.10) for only hypertension to 2.30 (95% CI: 2.10-2.53) for the joint diagnosis of all 3 conditions. An increased likelihood of a single or combined occurrence of 3 chronic conditions was observed with increased age. Conclusion: The multimorbidity distribution for diabetes mellitus, hypertension, and obesity differs significantly among male and female patients. The overall burden of morbidity, and mortality, however, tends to rise after 46 years of age, with the highest burden among individuals above 60 years of age.

Abstract Background Nanoparticles are small-scale substances ( Method ZnO nanoparticles were administered orally in two doses (either 600 mg or 1 g/Kg body weight/day for 5 conscutive days) to Wister albino rats. In order to detect the protective effects of the studied antioxidants against n-ZnO induced nepherotoxicity, different biochemical parameters were investigated. Moreover, histopathological examination of kidney tissue was performed. Results Nano zinc oxide-induced nephrotoxicity was confirmed by the elevation in serum inflammatory markers including: tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6); and C-reactive protein (CRP). Moreover, immunoglobulin (IGg), vascular endothelium growth factor (VEGF), and nitric oxide (NO) were significantly increased in rat serum. Serum urea and creatinine levels were also significantly increased in rats intoxicated with n-ZnO particles compared with the control group. Additionally, a significant decrease in the non-enzymatic antioxidant reduced glutathione (GSH) was shown in kidney tissues and serum glucose levels were increased. These biochemical findings were supported by a histopathological examination of kidney tissues, which showed that in the animals that received a high dose of n-ZnO, numerous kidney glomeruli underwent atrophy and fragmentation. Moreover, the renal tubules showed epithelial desquamation, degeneration and necrosis. Some renal tubules showed casts in their lumina. Severe congestion was also observed in renal interstitium. These effects were dose dependent. Cotreatment of rats with Qur and/or Arg along with n-ZnO significantly improved most of the deviated tested parameters. Conclusions The data show that Qur has a beneficial effect against n-ZnO oxidative stress and related vascular complications. Also, its combination with Arg proved to be even more effective in ameliorating nano zinc oxide nephrotoxicity.

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA), is associated with high morbidity and mortality rates with rapid development of resistance. Methods A total of 512 MRSA isolates were procured from 6 major hospitals in Riyadh, Saudi Arabia and antibiotic susceptibilities and MICs were documented against several antibiotics and vancomycin. SPSS version 10 was used for statistical analysis. Results The prevalence of MRSA in the study hospitals ranged from 12% to 49.4%. Mean patient age was 44 years with males constituting 64.4% and females 35.6%. Approximately 41.5% of the isolates came from patients in the extreme age groups. MIC for vancomycin was in the susceptible range for all isolates ranging from 0.25 to 3 ug/ml. The overall susceptibility of MRSA to the various antibiotics tested was: fusidic acid 4.3%, sulfamethoxazole/trimethoprim 33.8%, gentamicin 39.6%, mupirocin 77.0%, gatifloxacin 78.9%, chloramphenicl 80.7%, linezolid 95.1%, quinupristin/dalfopristin 100%. Some differences were noted in the resistance of isolates among the participating hospitals reflecting antibiotic usage. On the whole, inpatient isolates (accounting for 77.5% of the isolates) were more resistant than outpatient isolates (22.5%) except for linezolid. Quinupristin-dalfopristin and linezolid are the most effective antibiotics tested against inpatient isolates while quinupristin-dalfopristin and gatifloxacin seem to be the most effective against outpatient isolates. Approximately one forth of the isolates are no longer susceptible to mupirocin used for eradication of the carrier state reflecting resistance developing after widespread use. Trends over time show a tendency towards decreased susceptibility to gatifloxacin and linezolid with increasing susceptibility to gentamicin and sulfamethoxazole/trimethoprim. Conclusion Quinupristin/dalfopristin and linezolid are two valuable additions to our antimicrobial armamentarium, but resistance has already been described. To preserve their value, their use should be limited to those rare cases where they are clearly needed. Fusidic acid, the local antibiotic, gentamicin and trimethoprim/sulfamethoxazole should not be relied upon for treatment of MRSA infections, at least empirically as the percentage of susceptible isolates is very low.