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Waleed H Mahallawi,1 Wael A Alharbi,1 Sultan A Aloufi,1 Nadir A Ibrahim,1 Muntasir M Abdelrahman,2 Bader A Alhomayeed,2 Moutasem S Aboonq,3 Saeed Awad M Alqahtani,3 Emad S Rajih,4 Abdulaziz M Bakhsh,4 Ibrahim Sandokji5 1Medical Laboratory Technology Department, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia; 2King Fahad Hospital, Ministry of Health, Madinah, Saudi Arabia; 3Department of Physiology, College of Medicine, Taibah University, Madinah, Saudi Arabia; 4Urology Department, College of Medicine, Taibah University, Madinah, Saudi Arabia; 5Department of Pediatrics, College of Medicine, Taibah University, Madinah, Saudi ArabiaCorrespondence: Waleed H Mahallawi, Medical Laboratory Technology Department, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia, Email wmahallawi@gmail.comBackground: Kidney transplant recipients (KTRs) commonly suffer from impaired immunity. KTRs’ compromised immune response to COVID-19 vaccines indicates urgent revision of immunisation policies.Methods: A cross-sectional study was conducted in Madinah, Saudi Arabia of 84 KTRs who had received at least one dose of a COVID-19 vaccine. ELISA was used to evaluate anti-spike SARS-CoV-2 IgG and IgM antibody levels in blood samples obtained one month and seven months after vaccination. Univariate and multivariate analyses were performed to identify associations between seropositive status and factors such as the number of vaccine doses, transplant age, and immunosuppressive therapies.Results: The mean age of KTRs was 44.3 ± 14.7 years. The IgG antibody seropositivity rate (n=66, 78.5%) was significantly higher than the seronegativity rate (n=18, 21.4%) in the whole cohort (p< 0.001). In KTRs seroconverting after one month (n=66), anti-SARS-CoV-2 IgG levels declined significantly between one month (median [IQR]:3 [3– 3]) and seven months (2.4 [1.7– 2.6]) after vaccination (p< 0.01). In KTRs with hypertension, IgG levels significantly decreased between one and seven months after vaccination (p< 0.01). IgG levels also decreased significantly in KTRs with a transplant of > 10 years (p=0.02). Maintenance immunosuppressive regimens (triple immunosuppressive therapy and steroid-based and antimetabolite-based regimens) led to a significant decrease in IgG levels between the first and second sample (p< 0.01). KTRs receiving three vaccine doses showed higher antibody levels than those receiving a single dose or two doses, but the levels decreased significantly between one (median [IQR]: 3 [3– 3]) and seven months (2.4 [1.9– 2.6]) after vaccination (p< 0.01).Conclusion: KTRs’ humoral response after SARS-CoV-2 vaccination is dramatically inhibited and wanes. Antibody levels show a significant decline over time in KTRs with hypertension; receiving triple immunosuppressive therapy or steroid-based or antimetabolite-based regimens; receiving mixed mRNA and viral vector vaccines; and with a transplant of > 10 years.Keywords: SARS-CoV-2, kidney transplant recipients, booster, immunosuppression, COVID-19 vaccines, humoral immune response

Introduction: Graves' disease (GD) is an autoimmune disorder characterized by hyperthyroidism due to increased thyroid-stimulating hormone receptor antibodies (TRAb).The treatment of GD often consists of radioactive iodine therapy, anti-thyroid drugs (ATD), or thyroidectomy. Since few studies have collected data on remission rates after treatment with ATD in Saudi Arabia, our study aimed to assess the efficacy and the clinical predictors of GD long-term remission with ATD use., Method: We conducted a retrospective chart review study of 189 patients with GD treated with ATD between July 2015 and December 2022 at the endocrine clinics in King Abdulaziz Medical City in Riyadh. All GD patients, adults, and adolescents aged 14 years and older who were treated with ATD during the study period and had at least 18 months of follow-up were included in the study. Patients with insufficient follow-up and those who underwent radioactive iodine (RAI) therapy or thyroidectomy as first-line therapy for GD were excluded from the study., Results: The study sample consisted of 189 patients, 72% of whom were female. The patients' median age was 38years (33, 49). A total of 103 patients (54.5%) achieved remission. The median follow-up period for the patients was 22.0 months (9, 36). Patients who achieved remission had lower mean free T4 levels (25.8pmol/l ± 8.93 versus 28.8pmol/l ± 10.82) (P value = 0.038) and lower median TRAb titer (5.1IU/l (2.9, 10.7)) versus (10.5IU/l (4.2, 22.5)) (P value = 0.001) than patients who did not achieve remission. Thirty-five out of 103 patients who achieved remission (34%) relapsed after ATD discontinuation. The patients who relapsed showed higher median thyroid uptake on 99mTc-pertechnetate scan than patients who did not relapse: 10.3% (5.19, 16.81) versus 6.0% (3.09, 12.38), with a P value of 0.03. They also received ATD for a longer period, 40.0 months (29.00, 58.00) versus 25.0 months (19.00, 32.50), with a P value of < 0.0001., Conclusion: The remission of GD was achieved in approximately half of the patients treated with ATD; however, approximately one-third of them relapsed. Lower Free T4 and TRAb levels at diagnosis were associated with remission. Longer ATD use and higher thyroid uptake upon diagnosis were associated with relapse after ATD discontinuation. Future studies are necessary to ascertain the predictors of ATD success in patients with GD., (© 2024. The Author(s).)

Introduction: Bacterial meningitis poses significant medical challenges due to its acute inflammatory nature and potential for severe neurological complications, emphasizing the need for prompt diagnosis and treatment. Limited data exists on its epidemiology and antimicrobial resistance trends among hospitalized patients in Saudi Arabia. This study aimed to investigate these factors at a tertiary care hospital over six years., Methods: A retrospective analysis was conducted on cerebrospinal fluid samples results from 222 bacterial meningitis cases among hospitalized patients between 2018 and 2023. Demographic, clinical, microbiological data, and antibiotic susceptibility patterns were collected and analyzed., Results: Pseudomonas aeruginosa (43%) was the predominant pathogen isolated. Neonates (16%) and children (47%) were most affected population. Nosocomial meningitis accounted for 92% of cases, mainly in the intensive care settings (50.45%). Extended-spectrum beta-lactamase was the leading resistance pattern (12.2%). Seasonal variation was observed, with a peak incidence in October-November., Conclusion: The study highlights the substantial burden of bacterial meningitis among hospitalized patients, especially among high-risk groups. Emerging antimicrobial resistance emphasizes the need for optimized surveillance and stewardship. Future prospective research employing molecular techniques across multiple centers in the country is warranted to enhance understanding and guide public health strategies in Saudi Arabia., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Assessment of awareness and knowledge of the general population regarding Monkeypox is rarely investigated on a global level. The World Health Organization (WHO) reported a lack of knowledge about monkeypox as one of the main challenges facing authorities in implementing effective preventive strategies. This study aims to assess the awareness and knowledge of the general adult population about Monkeypox disease., Subjects and Methods: An online population-based cross-sectional study was carried out in Jeddah, Saudi Arabia, among a snowball sample of adult persons (>18 years old). A self-administered online Arabic and English questionnaires was utilized in this study. It consists of three main parts: sociodemographic characteristics of the patients, perception towards Monkeypox disease and assessment of the knowledge about Monkeypox disease through 23 multiple-choice questions with "Yes", "No" and "don't know" responses., Results: A total of 387 adults were included in the study. Females represented 72.6% of them. Almost two-thirds (63.8%) aged between 26 and 45 years. More than half (55.6%) of the participants believed that monkeypox will affect social and economic life like the COVID-19 pandemic while 30.7% considered Monkeypox as a conspiracy or bioterrorism. Overall, almost half (50.4%) of the participants expressed excellent level of knowledge, whereas only 4.4% had poor level of knowledge. The highest level of excellent knowledge about Monkeypox disease was observed among participants in the age group 26-45 years (55.1%), whereas the lowest was observed among those in the age group 46-60 years (39.7%), P = 0.001. More educated participants (university/postgraduates) were more knowledgeable about Monkeypox disease as 53.5% of them had excellent level of knowledge compared to 33.3% of those below secondary school educational level, P = 0.047., Conclusion: The knowledge of the general population about Monkeypox is acceptable. However, defective knowledge was observed regarding the fact that Monkeypox is not a new infection that appeared in the year 2022 as well as about the availability of a monkeypox vaccine in Saudi Arabia. Therefore, it is recommended to organize educational activities about the disease for general population targeted mainly lower educated and elderly subjects., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Objective: To examine changes in maternal feeding behaviors (MFB) and maternal feeding stress (MFS) among mothers of preschoolers in Saudi Arabia before and during the novel coronavirus pandemic., Methods: This is a prospective cohort study including 64 mothers of preschoolers who were drawn from a sample of a 2019 study. Study questionnaire was completed during November-December 2020. MFB were assessed using the Child Feeding Questionnaire-Arabic (CFQ-A) and MFS was assessed using the MFS-mealtimes index and the MFS-maternal resentment/difficult child index. Paired samples t -tests were used to examine changes in MFB and MFS., Results: Mothers have reported an increase in perceived responsibility ( M = 4.09, SD = 0.87 vs. M = 4.33, SD = 0.59, P -value < 0.05) and monitoring ( M = 4.23, SD = 0.73 vs. M = 4.48, SD = 0.66, P -value < 0.05) during the pandemic period compared to the period prior to the pandemic. Mothers have reported a decrease in use of food as a reward (M = 4.11, SD = 0.87 vs. M = 2.30, SD = 0.88, P -value < 0.001) and concern about child's diet ( M = 3.34, SD = 1.12 vs. M = 2.55, SD = 1.04, P -value < 0.001). There was an increase in MFS-maternal resentment/difficult child ( M = 2.47, SD = 0.68 vs. M = 2.71, SD = 0.72, P -value < 0.01)., Conclusions: Findings can help inform future research aiming to measure the long-term effects of the pandemic on child outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Mosli, Barahim, Zahed, Ishaq, Al-Eryani, Alharbi, Kutbi and Saleemani.)

Active cancer-associated fibroblasts (CAFs) are major components of the tumor microenvironment, which promote carcinogenesis and modulate response to therapy. Therefore, targeting these cells or reducing their paracrine pro-carcinogenic effects could be of great therapeutic value. To this end, we sought to investigate the effect of eugenol, a natural phenolic molecule, on active breast CAFs. We have shown that decitabine (5-Aza-2'-deoxycytidine, DAC) and eugenol inhibit the expression of the DNA methyltransferase genes DNMT1 and DNMT3A at both the protein and mRNA levels in breast CAF cells. While the effect of eugenol was persistent, DAC had only a transient inhibitory effect on the mRNA level of both DNMT genes. Furthermore, eugenol and DAC suppressed the invasive/migratory and proliferative potential of CAF cells as well as their paracrine pro-carcinogenic effects both in vitro and in humanized orthotopic tumor xenografts. Interestingly, these inhibitory effects of decitabine and eugenol were mediated through E2F1 downregulation. Indeed, ectopic expression of E2F1 upregulated both genes and attenuated the effects of eugenol. Additionally, we provide clear evidence that eugenol, like DAC, strongly modulates the methylation pattern in active CAF cells, through methylating several oncogenes and demethylating various important tumor suppressor genes, which affected their mRNA expression levels. Importantly, the E2F1 promoter was also hypermethylated and the gene downregulated in response to eugenol. Together, these findings show that the active features of breast CAF cells can be normalized through eugenol-dependent targeting of DNMT1/DNMT3A and the consequent modulation in gene methylation., (© 2021 Wiley Periodicals LLC.)

The global incidence of breast cancer among men is steadily growing. Despite this, compared to female breast cancer patients, there are very few studies on biomarkers in male breast cancer patients. A cross-sectional case control study was carried out to determine the serum levels of melatonin, ghrelin, dopamine, serotonin, epinephrine, and GABA in male breast cancer. All the recruited patients were obese, old, and had recently been diagnosed with the disease. They had not received any treatment for the cancer until the time of the study. Melatonin and epinephrine serum levels were significantly higher in breast cancer patients compared to their age-matched controls, whereas ghrelin, dopamine, GABA, and serotonin serum levels were lower in patients compared to the control group. The serum levels of most of the studied biomarkers in male breast cancer patients were similar to those observed in female breast cancer patients, except for serum melatonin levels.