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Lubna Al Asoom,1 Maha A Alassaf,2 Najd S AlSulaiman,3 Dhuha N Boumarah,4 Aldana M Almubireek,2 Gaeda K Alkaltham,2 Hussain A Alhawaj,5 Taleb Alkhamis,5 Nazish Rafique,1 Ahmed Alsunni,1 Rabia Latif,1 Seham Alsaif,1 Dana Almohazey,6 Sayed AbdulAzeez,7 J Francis Borgio7 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2King Fahd hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Internal Medicine, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 5Animal House, Environmental Health Department, Institute for Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 6Department of Stem Cell Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 7Department of Genetic Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Lubna Al Asoom, Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O Box 2004, Dammam, 31541, Saudi Arabia, Tel +966505846344, Email lasoom@iau.edu.saBackground: Obesity is a global pandemic that is associated with high morbidity and mortality. Natural herbs are commonly used for weight reduction and appetite suppression. Therefore, we aim to investigate the role and mechanism of Nigella sativa (NS) and ginger on weight reduction and appetite regulation.Methods: This experimental study was performed at Imam Abdulrahman Bin Faisal University. Twenty-five female rats were distributed into 5 groups: NS (oral 1000mg/kg), Ginger (500 mg/kg), NS-ginger (both interventions), a positive control (intraperitoneal 50 μg/kg Liraglutide), and a negative control. Each intervention was given for 9 weeks. Food intake and body weight were assessed weekly. Serum lipid profile and peptides involved in appetite control (cholecystokinin (CCK), glucagon-like peptide 1(GLP-1), gastric inhibitory polypeptide (GIP), ghrelin, peptide YY, and orexin) were assayed at the end of the experiment.Results: None of the interventions showed a statistically significant difference regarding food consumption or weight gain (p > 0.05). However, the three interventions significantly reduced total cholesterol (TC), NS and NS-ginger significantly increased HDL, NS increased ghrelin and ginger increased orexin.Conclusion: The present dose and duration of NS, ginger, or in combination did not demonstrate a significant change in body weight or food consumption in comparison to the negative or positive controls. However, NS or ginger has improved the lipid profile by reducing TC and increasing HDL. In addition, NS or ginger can influence some of the peptides involved in appetite regulation such as the increase in ghrelin induced by NS and the reduction of orexin induced by ginger. We believe that these latter effects are novel and might indicate a promising effect of these natural products on appetite regulation.Keywords: Nigella sativa, ginger, body weight, appetite, Liraglutide

Rabia Latif,1 Nazish Rafique,1 Lubna Al Asoom,1 Ahmed A Alsunni,1 Ayad Mohammed Salem,1 Kholoud Al Ghamdi,1 Rasha AlNujaidi,2 Maha Alblaies,2 Sara Alali,2 Leyan Alotaibi,2 Nada Alghamdi2 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Rabia Latif, Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, PO Box: 1982, Dammam, 31441, Saudi Arabia, Tel +966 3 8577000 3335134, Email rlhussain@iau.edu.saObjective: COVID-19 is a public health emergency of international concern. There is still no definitive cure for this highly transmittable illness. Immunization and breaking the chain of infection is the only successful approach to mitigate its spread. Our study explored the adherence to COVID-19 preventive measures and its associating factors among Health Care Professionals (HCPs) working in Saudi Arabia.Methods: For this cross-sectional study, an online survey was conducted from December 01, 2020, to March 31, 2021, among 978 HCPs in Saudi Arabia. The self-administered questionnaire consisted of demographic information, COVID-19 preventive behaviors, knowledge, attitude, fear, and risk. Mann–Whitney U-test, Kruskal–Wallis one-way analysis, Spearman correlation, and binary logistic regression tests were used in data analysis.Results: Most of the HCPs were Saudi nationals (86.9%), females (63.1%), age group 20– 29 years (42.3%), Middle Eastern ethnicity (82.5%), and working in the government sector (80.8%). A 52.2% of the participants were compliant with COVID-19 preventive behavior. The most and the least compliant preventive behaviors were “wearing masks” (88.8% compliance) and “keeping social distancing” (60.7% compliance). Preventive behavior was significantly higher in HCPs having a) more knowledge of COVID-19 (U=104849; p 0.001); b) positive attitude (U=84402; p 0.001); c) higher fear (U=103138; p less than 0.001) and d) nursing profession (p 0.01). COVID-19 knowledge (p< 0.001), attitude (p< 0.001), and fear (p< 0.001) contributed significantly to the prediction of preventive behavior compliance. A unit increase in COVID-19 knowledge, attitude, and fear scores raised the odds of being compliant with preventive behavior by factors of 2.34, 1.87, and 1.53 respectively.Conclusion: About half of the study participants were compliant with COVID-19 preventive behavior. Preventive behavior is significantly higher among HCPs having more knowledge of COVID-19, more fear, a positive attitude, and the “nursing” profession. Having more knowledge, a positive attitude, and more fear of COVID-19 may increase the likelihood of being compliant with preventive behavior.Keywords: health care professionals, health personnel, COVID-19, prevention, behavior

Lubna Al Asoom,1 Johra Khan,2,3 Ahmad Al Sunni,1 Nazish Rafique,1 Rabia Latif,1 Majed Alabdali,4 Sayed AbdulAzeez,5 J Francis Borgio5 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31541, Saudi Arabia; 2Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia; 3Health and Basic Sciences Research Center, Majmaah University, Majmaah, 11952, Saudi Arabia; 4Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 31952, Saudi Arabia; 5Department of Genetic Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, 31441, Saudi ArabiaCorrespondence: Lubna Al Asoom, Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O Box 2004, Dammam, 31541, Saudi Arabia, Tel +966505846344, Email lasoom@iau.edu.sa Johra Khan, Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia, Tel +966538077360, Email j.khan@mu.edu.saBackground: Mitochondrial DNA (mtDNA) mutations have been reported in multiple neurological diseases and helped to explain the pathophysiology of these diseases. Similarly, variations in mtDNA might exist in migraine and can explain the effect of low ATP production in the neurons on the initiation of migraine attack. Therefore, in the current study we aim to explore the association of mtDNA mutations on migraine in the Saudi population.Subjects and Methods: Over 1950 young Saudi female students were screened for migraine, among that a total of 103 satisfied the ICHD-3 criteria. However, 20 migraine cases confirmed in the neurology clinic and gave consent to participate in the study. Another 20 age-matched healthy controls were also recruited. Mitochondrial sequence variations were filtered from exome sequencing using NCBI GenBank Reference Sequence: NC_012920.1 and analysed using MITOMAP. Genes with significant single nucleotide polymorphisms (SNPs) were investigated by the gene functional classification tool DAVID and functional enrichment analysis of protein–protein interaction networks through STRING 11.5 for the most significant associated genes.Results: Genome wide analysis of the mitochondrial sequence variations between the patients with migraine and control revealed the association of 30 SNPs (p < 0.05) in the mitochondrial genome. The highest significance (p = 0.001033) was observed in a coding SNP (rs1603225278) in the CYTB gene and rs386829281 in the region of origin of replication. Twenty-four significant SNPs were in the coding region of nine (ND5, ND4, COX2, COX1, ND3, CYTB, COX3, ND2 and ND1) genes.Conclusion: This is the first study to demonstrate the association of mtDNA variations with migraine in the Saudi population. The current findings will help to highlight the significance of mtDNA mutations to migraine pathophysiology and will serve as a reference data for larger national and international studies.Keywords: mitochondrial DNA, Saudi Arabia, mtDNA variations, migraine, CYTB gene

Ayad Mohammed Salem,1 Noor Al Khathlan,2 Abdulelah Fawzi Alharbi,3 Turki Alghamdi,3 Saleh AlDuilej,3 Mohammed Alghamdi,3 Majed Alfudhaili,3 Ahmed Alsunni,1 Talay Yar,1 Rabia Latif,1 Nazish Rafique,1 Lubna Al Asoom,1 Hussein Sabit4 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of respiratory care, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Genetics, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Ayad Mohammed SalemDepartment of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, PO Box 2114, Dammam, 31451, Saudi ArabiaEmail ayadsalem@iau.edu.saBackground: The sequelae of COVID-19 pneumonia on pulmonary function and airways inflammation are still an area of active research.Objective: This research aimed to explore the long-term impact of COVID-19 pneumonia on the lung function after three months from recovery.Methods: Fifty subjects (age 18– 60 years) were recruited and classified into two groups: the control group (30 subjects) and the post-COVID-19 pneumonia group (20 patients). Pulmonary function tests, spirometry, body plethysmography [lung volumes and airway resistance (Raw)], diffusion capacity for carbon monoxide (DLCO), and fractional exhaled nitric oxide (FeNO), were measured after at least 3 months post-recovery.Results: Significant reduction in total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FEV, and diffusing capacity for carbon monoxide (DLCO) was observed in post-COVID-19 subjects compared to controls. Restrictive lung impairment was observed in 50% of post-COVID-19 cases (n = 10) compared to 20% in the control group (n = 6, P = 0.026). In addition, mild diffusion defect was detected in 35% (n = 7) of the post-COVID-19 group compared to 23.3% (n = 7) in the controls (P = 0.012).Conclusion: COVID-19 pneumonia has an impact on the lung functions in terms of restrictive lung impairment and mild diffusion defect after three months from recovery. Therefore, a long-term follow-up of the lung function in post-COVID-19 survivors is recommended.Keywords: COVID-19, pneumonia, PFT, DLCO, FeNO

Rabia Latif,1 Nazish Rafique,1 Lubna Al Asoom,1 Ahmed A Alsunni,1 Ayad Mohammed Salem,1 Dinah Abdulhadi AlNoaimi,2 Wasan Mohammed AlHarbi,2 Ahad Yasir Shaikh,2 Shoug Abdullah AlRaddadi,2 Leena Abdulrahman AlMuhaish,2 Dana Almohazey,3 Sayed Abdulazeez,4 J Francis Borgio4 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Stem Cell Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Department of Genetic Research, Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Rabia LatifDepartment of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi ArabiaTel +966 596212648Fax +966 38578048Email rlhussain@iau.edu.saBackground: A reliable, migraine-specific biomarker has not been identified so far. Calcitonin Gene-Related Peptide (CGRP) and Apolipoprotein E (ApoE) might serve as migraine biomarkers due to their roles in migraine pathophysiology. However, their diagnostic usefulness has not been explored yet. Present study explored the diagnostic accuracy of CGRP and ApoE in migraine.Methods: A cross-sectional, case–control study was conducted from November 2019 to April 2020 at Physiology department of our university. Fourteen female migraine patients, 18– 25 years old, with confirmed “Migraine” diagnosis by a neurologist, were recruited. Control group consisted of 14 age-matched healthy females with no personal/family history of migraine. Blood was drawn once from control subjects and twice from migraine patients (ictal and interictal phase). Serum CGRP and ApoE levels were assessed by ELISA. Statistical analysis involved paired t-test, one-way ANOVA, Receiver operating characteristic (ROC) curves and cross-tabs.Results: ApoE (mg/dl) was higher significantly in interictal (1.90± 0.50) and ictal (1.97± 0.65) phases of migraine compared to control (1.07± 0.26) (p ≤ 0.001). ROC curves for ApoE were significant in migraine ictal vs control (AUC= 0.91, AUC 95% CI: 0.78– 1.0) and migraine interictal vs control (AUC=0.92, AUC 95% CI: 0.8– 1.0) subjects. ROC curve for CGRP (pg/mL) was significant in migraine ictal vs control subjects only (AUC=0.79, AUC 95% CI: 0.6– 0.97).Conclusion: Serum ApoE has “excellent” accuracy to diagnose migraine patients whether in ictal or interictal phase, from healthy subjects. ApoE levels of patients in these two phases of migraine are raised significantly than healthy subjects. CGRP has “fair” diagnostic accuracy to discriminate between migraine ictal phase and healthy subjects. Its levels do not differ significantly among migraine ictal, interictal phase and healthy controls.Keywords: apolipoprotein E, calcitonin gene-related peptide, migraine, receiver operating curve, biomarkers

Lubna Al Asoom Physiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Lubna Al Asoom, Physiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. 2114, Dammam, 31541, Saudi Arabia, Tel +966 133335131, Email lasoom@iau.edu.saAbstract: Obesity is one of the major health-threatening conditions nowadays. Nigella sativa (NS) is a medicinal plant that demonstrates multiple therapeutic effects. In the current review, we aim to evaluate the weight lowering effect of NS in both clinical trials and experimental studies and to explore the possible reported mechanisms of this effect. We searched PubMed and Web of science and retrieved 14 clinical trials and 5 experimental studies that justify our inclusion criteria. After the analysis of these articles, we can conclude that long-term administration of NS for 6– 12 weeks can significantly lower bodyweight and other anthropometric indices. NS-oil is more potent than NS-powder in lowering bodyweight probably due to the higher concentration of fatty acids and thymoquinone. The weight lowering effect of NS is not a toxic effect, it conversely and preferably lowers the elevated liver enzymes in condition of fatty liver. It is also frequently accompanied by positive metabolic modifications, such as enhancement of lipid profile, lowering blood glucose and improving insulin resistance. Possible mechanisms for NS-bodyweight lowering effect might include an appetite-suppression effect, lowering caloric-intake and inhibition of intestinal glucose absorption. However, further experimental evidence is required to support these mechanisms or unveil new ones.Keywords: Nigella sativa, obesity, bodyweight, BMI, waist-circumference

Lubna Ibrahim Al Asoom,1 Marwah Mansour Al Makhaita,1 Nazish Rafique,1 Dina Tariq Al Afandi,2 Waad Mohammed Al Otaibi,3 Hind Saleh Alsuwat,3 Mousa A Alaithan,3 Sayed AbdulAzeez,3 J Francis Borgio3 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Depatment of Pediatrics, College of Medicine, King Fahd Hospital of the University, Dammam, Saudi Arabia; 3Department of Genetic Research, Institute for Research and Medical Consultation (IRMC), Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Lubna Ibrahim Al AsoomDepartment of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaEmail lasoom@iau.edu.saIntroduction: Hemoglobinopathies are common disorders in Saudi Arabia and have an impact on the general health of the affected individuals. The current study aimed to find out the effects of the presence of α 3.7 kb rightward deletion or sickle-cell trait (SCT) on ventilatory and hemodynamic parameters of maximum exercise testing in young Saudi women.Methods: In a cross-sectional study, 75 randomly selected female students from different colleges were tested for VO2max using a COSMED system for maximum exercise testing. Blood parameters and globin genotyping were determined.Results: Hemoglobin genetic studies revealed 28 of the students had 3.7 α-globin deletion only (− 3.7α2/α1α2), five had SCT, and 42 had normal α-globin (α1α2/α1α2 and no HbS) and were considered the control group. Subjects with − 3.7α2/α1α2 showed significantly lower VO2max and higher resting systolic blood pressure, while SCT carriers showed no difference in regard to ventilatory parameters, but had higher post-exercise systolic blood pressure than controls.Conclusion: It is concluded that individuals with 3.7 α-globin deletion might have lower fitness capacity, as demonstrated by lower VO2max, which might explain the general lower VO2max in the young women of this population. Furthermore, increments in resting systolic and posteexercise systolic blood pressure in 3.7 α-globin deletion and SCT, respectively, might indicate a future risk of cardiovascular diseases and require attention and extensive studies.Keywords: cardiopulmonary exercise testing, exercise test, α-globin, sickle-cell trait, blood pressure, Saudi Arabia

Lubna Ibrahim Al Asoom,1 Dina Tariq Al Afandi,2 Aseel Salah Al Abdulhadi,3 Nazish Rafique,1 Shahanas Chathoth,4 Ahmad A Al Sunni1 1Physiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Pediatrics Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 4Biochemistry Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Lubna Ibrahim Al Asoom Email lasoom@iau.edu.saBackground: Obesity is a major health threat worldwide. It predisposes individuals to diabetes, cardiovascular complications, and cancer. Genetic and environmental factors are responsible for the increasing incidence of obesity. In this study, we investigated the genetic factors associated with obesity in young Saudi women.Subjects and Methods: In this cross-sectional study, 131 young Saudi female students were recruited. Body mass index (BMI), waist–hip ratio, blood glucose, triglyceride, cholesterol, HDL, LDL, and vitamin D3 levels of the subjects were determined. Twelve SNPs of different genes that showed a correlation with obesity in different population were tested, namely GNPDA2 (rs10938397), TCF7L2 (rs10885409), FTO (rs1477196), ADIPOQ (rs1501299), MC4R (rs17782313), ABCA1 (rs1800977), FTO (rs1861868), VDR (rs2228570), VDR (rs731236), VDR (rs7975232), ADIPOQ (rs266729), and PFPK (rs6602024). Student’s t-test was conducted for all parameters. Pearson correlation was performed to identify the correlated variables. The frequencies of different risk alleles were determined by direct counting of the test allele divided by the total number of alleles and compared.Results: Only two SNPs, rs1861868 of FTO and rs7975232 of VDR, of the twelve tested SNPs showed significant protective associations with the BMI with odds ratio 0.3886 (0.1761– 0.8572); p 0.0192 and odds ratio 0.4563 (0.2343– 0.8888); p 0.0211, respectively.Conclusion: The current study showed that minor alleles, “T” of FTO and “A” of VDR, might be protective factors against increased BMI in young Saudi female subjects. To elucidate this association, further studies with larger sample size involving both sexes are required.Keywords: BMI, obesity, body weight, FTO gene, VDR gene, polymorphism

Nazish Rafique,1 Fatimah Al Tufaif,2 Wala Alhammali,2 Reem Alalwan,2 Alzahraa Aljaroudi,2 Fatimah AlFaraj,2 Rabia Latif,1 Lubna Ibrahim Al-Asoom,1 Ahmed A Alsunni,1 Kholoud S Al Ghamdi,1 Ayad M Salem,1 Talay Yar1 1Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Nazish Rafique, Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, Tel +966 5035042329, Fax +966 38578048, Email nryahmed@uod.edu.saPurpose: This study aimed to determine the stress levels and identify various factors responsible for causing high-stress scores during the COVID-19 pandemic in the Saudi population.Patients and Methods: This cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University, Dammam, from June 2020 until December 2020 on 4052 respondents from the Eastern province of Saudi Arabia. An online survey was used to collect information about various stress factors. The psychological impact of COVID-19 was measured by using the COVID-19 impact event scale (COVID-19 IES), whereas general stress levels were assessed by K10 Kessler Psychological Distress Scale (K10).Results: The psychological impact of the COVID-19 outbreak revealed that 35.4% of participants suffered from moderate or severe psychological impact (score> 33); 19.7% had a mild psychological impact (scores24– 32), whereas 44.9% reported minimal psychological impact (score < 23). The factors significantly associated with higher stress scores and COVID-19 IES included male gender, low monthly income, having a private business, living in apartments/residential complexes, poor general health status, visit hospital/doctor in the past three months, presence of chronic disease, direct/indirect contact with someone diagnosed with/suspected to have COVID-19, contact with surfaces/tools infected with COVID-19, getting screened or quarantined for COVID-19, follow-up of the latest news about COVID-19 and knowledge of a greater number of people infected and died with COVID-19 (p < 0.05). In contrast, being an elementary school student, having 4– 10 children, observing various protective measures, and staying home for 4– 12 hours were associated with lower COVID-19 IES (p < 0.05).Conclusion: During the initial six months of the COVID-19 outbreak in Saudi Arabia, 35.4% participants suffered from moderate to the severe psychological impact. This study identified various factors responsible for high COVID-19 IES and K10 stress scores. These findings can help formulate psychological interventions for improving the stress scales in vulnerable groups during the COVID-19 pandemic.Keywords: COVID-19, stress, psychological impact, Saudi Arabia

Background: Migraine is a genetic disorder characterized by recurrent episodes of headache that are throbbing in nature. The objective of this study was to directly compare the efficacy and safety of anti-calcitonin gene-related peptide (anti-CGRP) and botulinum neurotoxin (BoNT) for the preventive treatment of chronic migraine., Methods: This quasi-experimental comparative study was conducted on 80 "chronic migraine patients" at King Fahad University Hospital, Dammam, KSA. Chronic migraineurs were divided into two groups (40 patients/group) and were treated with the standard doses of BoNT (group I) and anti-CGRP (group II). All the patients filled out the migraine pain scale, migraine disability assessment score, headache impact test (HIT-6), and adverse drug event questionnaire before the start and at the end of 9 months of treatment., Results: Most of the patients were females (76.3% vs. 23.8%) and were suffering from migraine for more than 24 months (66%). The mean age of the participants was 39.07 ± 10.01 years. Both BoNT and anti-CGRP groups showed a statistically significant decrease in mean HIT-6 and pain scores after 9 months of intervention. A direct comparison between the two treatment groups showed that the anti-CGRP drug caused a higher decrease in HIT-6 and pain scores as compared to the botulinum drug, but the difference was not statistically significant (P = 0.075 and 0.07, respectively). The most common adverse effect was "headache", reported by 45% and 40% of patients, followed by "pain at the site of injection" reported by 27.5% and 32.5% of BoNT and anti-CGRP groups, respectively. The two groups did not differ significantly in the frequency of adverse effects such as nausea, vomiting, visual problems, etc., except "joint stiffness". A significantly higher number of anti-CGRP patients experienced joint stiffness as compared to the BoNT group (17.5% vs. 0%, P = 0.006)., Conclusion: A direct comparison between the two treatments indicated that neither of the two interventions is statistically superior to the other in terms of efficacy and both are equally effective in the management of migraine. However, BoNT can be preferred over anti-CGRP because of its cost-effectiveness., Competing Interests: The authors declare no conflict of interest., (Copyright 2024, Mohammad Alabdali et al.)

Objectives: In this study, we aimed to assess the maximal oxygen uptake (VO 2max ) of young, healthy, non-athletic Saudi men using maximum graded exercise with instant breath-by-breath analysis and to compare this value to the predicted VO 2max by international formulae. Methods: In this cross-sectional study, 88 young non-athletic normal-weight Saudi subjects were recruited from Eastern Province of Saudi Arabia with mean age (21.3 ± 1.5 years), weight: (64.7 ± 7.5 kg), height: (172.3 ± 6.1 cm) and body mass index: (21.8 ± 2.1). All subjects were interviewed and examined for eligibility, after which they performed maximum graded exercise testing on a treadmill to obtain VO 2max . The predicted VO 2max was also generated using the following formulae (Edvardsen, Fairbarns, FRIENDS, Hansen, and Jones). Results: The mean measured VO 2max was 41.9 ± 7.2 ml/kg/min. While the predicted VO 2max using the formulae were: Edvardsen = 66.8 ± 7.9, Fairbarns = 64.1 ± 4.7, FRIENDS = 53.5 ± 2.2, Hansen = 42.8 ± 0.54, and Jones = 50.9 ± 5.1 ml/kg/min. There was a significant difference between all the predicted VO 2max and the measured one using the paired t-test (P < 0.001), except for the Hansen's predicted value (P = 0.212). The effect size index (Cohen's d) for the comparison of Hansen's VO 2max and measured VO 2max was trivial and equal to 0.13. The Bland-Altman test showed good agreement between the measured and Hansen's predicted VO 2max . Conclusion: This study demonstrated the mean VO 2max value of young, healthy, and non-athletic Saudi men. This value was lower than Western values, which might be due to low physical activity or racial differences. Most international formulae overestimate the VO 2max in this population, except for the Hansen equation. Therefore, Hansen's predicted VO 2max might be the best available reference value for the diagnosis and prognosis of young Saudi individuals undergoing maximum exercise testing., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Background and aim It has been shown that olfactory dysfunction is one of Coronavirus disease-2019 (COVID-19)common and puzzling symptoms that may persist weeks after the infection. This study aimed for the objective assessment of persisting olfactory dysfunction in post-COVID-19 patients. It also investigated the factors associated with the development of such symptoms in the Eastern Province of Saudi Arabia., Methods: A cross-sectional study that was conducted in the Department of Physiology, College of Medicine, Imam Abdulrahman bin Faisal University, Khobar, Saudi Arabia. One hundred and forty-seven participants were included in this study, and sixty of them agreed  to participate in the objective testing using the Connecticut Chemosensory Clinical Research Center (CCCRC) olfaction test., Results: There was a significant correlation between the following factors: (1) Persistence of anosmia/hyposmia and the time of onset of anosmia/hyposmia (P=0.015). (2) Persistence of anosmia/hyposmia and the duration of anosmia/hyposmia (P=0.012). (3) Duration of anosmia/hyposmia and the duration of COVID-19 symptoms (P=0.010). Interestingly, there was a significant association between the subjective participants' claim of anosmia/hyposmia and the score of their objective assessment (P=0.026)., Conclusion: The current study demonstrated that post-COVID-19 participants with delayed onset of anosmia/hyposmia and/or longer duration of either anosmia/hyposmia or COVID-19 symptoms were prone to have persistent olfactory dysfunction. Further studies are necessary to uncover the underlying pathophysiology and management of this olfactory dysfunction in COVID-19 patients.

Migraine, as the seventh most disabling neurological disease with 26.9% prevalence in Saudi females, lacks studies on identifying associated genes and pathways with migraines in the Arab population. This case control study aims to identify the migraine-associated novel genes and risk variants. More than 1900 Arab ancestry young female college students were screened: 103 fulfilled the ICHD-3 criteria for migraine and 20 cases confirmed in the neurology clinic were included for the study with age-matched healthy controls. DNA from blood samples were subjected to paired-end whole-exome sequencing. After quality control, 3365343 missense, frameshift, missense splice region variants and insertion-deletion (indels) polymorphisms were tested for association with migraine. Significant variants were validated using Sanger sequencing. A total of 17 ( p -value 9.091 × 10 -05 ) functional variants in 12 genes ( RETNLB , SCAI , ADH4 , ESPL1 , CPT2 , FLG , PPP4R1 , SERPINB5 , ZNF66 , ETAA1 , EXO1 and CPA6 ) were associated with higher migraine risk, including a stop-gained frameshift (-13-14*SX) variant in the gene RETNLB (rs5851607; p -value 3.446 × 10 -06 ). Gene analysis revealed that half of the significant novel migraine risk genes were expressed in the temporal lobe ( p -value 0.0058) of the cerebral cortex. This is the first study exploring the migraine risk of 17 functional variants in 12 genes among Saudi female migraineurs of Arab ancestry using whole-exome sequencing. Half of the significant genes were expressed in the temporal lobe, which expands migraine pathophysiology and early identification using biomarkers for research possibilities on personalised genetics.

Family trio next-generation sequencing-based variant analysis was done to identify the genomic reason on unexplained recurrent pregnancy loss (RPL). A family (dead fetus and parents) from Saudi Arabia with an earlier history of three unexplained RPLs at the ninth week of pregnancy was included in the study. Whole-genome sequencing (WGS) of a dead fetus and the parents was done to identify the pathogenic variation and confirmed through Sanger sequencing. WGS of dead fetus identifies a novel homozygous exonic variation (NM&#95;017419.3:c.680G>T) in ASIC5 (acid-sensing ion channel subunit family member 5) gene; the parents are heterozygous. Newly designed ARMS PCR followed by direct sequencing confirms the presence of heterozygous in one subject and absence of homozygous novel mutation among randomly selected healthy Saudis. The second family with heterozygous was confirmed with three unexplained RPLs. Pathogenicity analysis of R227I amino acid substitution in ASIC5 protein through molecular docking and interaction analysis revealed that the mutations are highly pathogenic, decrease the stability of the protein, and prevent binding of amiloride, which is an activator to open the acid-sensing ion channel of ASIC5 . The identified rare and novel autosomal recessive mutation, c.680G>T:p.R227I (ASIC5 Saudi ), in two families confirm the ASIC5 gene association with RPL and can be fatal to the fetus., 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 © 2021 Al Qahtani, AbdulAzeez, Almandil, Fahad Alhur, Alsuwat, Al Taifi, Al-Ghamdi, Rabindran Jermy, Abouelhoda, Subhani, Al Asoom and Borgio.)

Introduction: Detection of β-thalassemia trait or carriers (β-TT) depends significantly on an increase in Hemoglobin A 2 (HbA 2 ) levels, which is found at low levels (<3%) in normal healthy individuals and elevated levels (≥3.5%) in β-TT individuals. The study was designed to evaluate the reliability of the diagnostic parameter HbA 2 in the differentiation of β-TT and non-β-TT in Saudis., Methods: The widely used high performance liquid chromatography (Variant II Bio-Rad) was used to measure HbA 2 levels in blood. Sanger sequencing was used to screen the variation in globin genes (HBB, HBD, HBA1, and HBA2). All the study subjects were divided into βTT and non-βTT (wild) categories based on the presence or absence of HBB variations and further sub-divided into false positive, true positive, false negative, and true negative, based on HbA 2 values., Results: Out of 288 samples, 96 had HBB gene mutations. Of the 96 β-TT samples, sickle cell trait (SCT) samples (n = 58) were excluded, while the remaining (38 β-TT) were included in the detailed analysis: seven subjects with the HBB mutation had normal HbA 2 (<3%), and three were borderline (3.1-3.9%). The remainder (n = 28) had an elevated HbA 2 level (>4%). Based on HbA 2 analysis alone, both these groups would be incorrectly diagnosed as normal. Similarly, of the 189 non-β-TT samples, 179 had normal HbA 2 , eight had borderline HbA 2 , and two had a HbA 2 level above 4%. Based on HbA 2 analysis alone, borderline and >4% HbA 2 individuals, negative for β-TT, can be incorrectly diagnosed as carriers., Conclusion: Given the percentage of samples falling in the HbA 2 "borderline" and "normal" categories, it can be concluded that HbA 2 has a measure of unreliability in the diagnosis of β-thalassemia carriers.

Background/aims: The frequency of gastroesophageal reflux (GER) among asthmatic patients was found to range from 34% to 89% at different locations. The aims of this study have been to determine the frequency of GER in patients with asthma in the Saudi environment, to ascertain the main mechanism whereby GER triggers asthma, and to seek any evidence whether asthma can also trigger GER., Methodology: Fifty asthmatic patients were consecutively recruited as they reported to King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia, in the period from February 2000 to February 2001; their mean age +/- SD was 38.0 +/- 9.8 years. Twenty-two subjects without asthma or GER served as controls; their mean age +/- SD was 29.4 +/- 8.6. Both groups were subjected to a questionnaire, esophageal manometry, dual probe ambulatory 24-hour pH monitoring, and pulmonary function tests., Results: Among the asthmatic group 22 patients (44%) had GER. Accordingly, the asthmatic patients were divided into two groups: asthmatic with GER (n=22), and asthmatic without GER (n=28). Hoarseness of voice and nocturnal symptoms were found to be significant predictors for the presence of GER in asthmatics. Manometry revealed that asthmatic patients with GER had higher gastric pressure (11.4 +/- 4.0 mmHg vs. 8.4 +/- 2.8 mmHg; p=0.006) and lower resting pressure at the lower esophageal sphincter (LES) (21.2 +/- 8.7 mmHg vs. 28.2 +/- 9.3 mmHg; p=0.013) when compared with controls, both factors favoring the occurrence of reflux. With regard to pH data, acid reflux occurred both at the distal and proximal esophagus but the percent total acid exposure time was about 7 times longer at the distal than at the proximal esophagus (5.80 vs. 0.9). In addition, gastric pressure was positively and significantly correlated with distal esophageal acid exposure time and the DeMeester score, negatively correlated with spirometric parameters in asthmatic patients, as well as found to be a significant predictor of the severity of asthma (p=0.006)., Conclusions: Forty-four percent of the sample of asthmatic patients reporting to KFHU had GER. Since distal esophageal total acid exposure time was nearly 7 times longer than at the proximal esophagus, the main mechanism for GER triggering asthma is the vagally mediated reflex initiated by acid in the distal esophagus. In addition, the positive correlation of increased gastric pressure with the distal esophageal acid exposure time and the DeMeester score, its negative correlation with spirometric parameters and being a significant predictor of asthma severity suggest that severe asthma may trigger or aggravate GER.

Objective: The objective is to correlate the symptoms of gastroesophageal reflux with the results of esophageal reflux with the results of esophageal pH metry in asthmatic patients., Methods: A prospective study was carried out in King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia (KSA), during the period January 2000 through to February 2001, whereby 50 patients (34 females and 16 females) with primary diagnosis of bronchial asthma were consecutively enrolled, their mean age + SD was 38.01 + 9.8 years. Twenty-two subjects who were not suffering from asthma or gastroesophageal reflux (GER) (13 females and 9 males) constituted the control group. A questionnaire was administered to all participants and demographic data; asthma and GER symptoms were obtained. Esophageal manometry was performed, whereby the location, length and resting pressure of the lower esophageal sphincter (LES) were determined, pH catheter was inserted nasogastrically, and ambulatory pH data over 24 hours were collected. Pulmonary function tests were also performed., Results: Twenty-two (44%) patients with asthma had a Demeester score greater than 14.7 and were therefore diagnosed as having pathological GER. Accordingly, the asthma patients were divided into 2 groups, asthma patients with GER (n=22) and those without GER (n=28). Multiple logistic regression analysis revealed that age did not significantly influence occurrence of GER, but it indicated that hoarseness of voice and nocturnal symptoms were significant predictors for the presence of GER in asthmatic patients, hence, the probability of having GER in an asthma patient is nearly 8 times if he/she has nocturnal symptoms and about 7 times if they have hoarseness of voice. However 36.4% of asthmatic patients diagnosed by esophageal ph metry as having GER did not complain of heartburn and hoarseness of voice; such as the reflux was silent., Conclusion: The frequency of GER among 50 patients with asthma reporting to KFHU, Al-Khobar, KSA is 44%. The presence of nocturnal symptoms and hoarseness of voice are significant clinical predictors of GER in asthmatic patients. Patients with difficult to treat asthma should be subjected to esophageal pH metry since a substantial proportion of them may have silent reflux.