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Abdulmajeed Alshowair,1 Saleh Altamimi,1 Faisal A Alruhaimi,1 Saad Alshahrani,2 Fatima Alsuwailem,3 Mona Alkhaldi,4 Haiam Abdalla,5 Fahad Hamad Alkhuraiji,6 Montaser Saad Alaqeel,6 Salman Sulaiman Almureef,7 Salman Alhawasy,8 Amro Abdel-Azeem3,9 1Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 2Academic and Training Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 3Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 4Health Administration Office, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 5Model of Care, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 6Financial Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 7Cost Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 8Reporting Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 9Department of Community, Environmental and Occupational Medicine, Faculty of Medicine Zagazig University, Zagazig, EgyptCorrespondence: Amro Abdel-Azeem, Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia, Tel +966547135224, Email dr_amro_osh@hotmail.comPurpose: This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM).Methods: This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP).Results: Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient.Conclusion: MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.Keywords: cost-savings, multi-disciplinary team, complications, type 2 diabetes, predictive model

Mohammed S Alqahtani,1,2 Mohamed Abbas,3,4 Abdullah Alsabaani,5 Amjad Alqarni,1 Hussain M Almohiy,1 Entisar Alsawqaee,1 Raghad Alshahrani,1 Shahd Alshahrani1 1Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia; 2BioImaging Unit, Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH, U.K; 3Electrical Engineering Department, College of Engineering, King Khalid University, Abha, 61421, Saudi Arabia; 4Computers and Communications Department, College of Engineering, Delta University for Science and Technology, Gamasa, 35712, Egypt; 5Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi ArabiaCorrespondence: Mohamed Abbas, Electrical Engineering Department, College of Engineering, King Khalid University, Abha, 61421, Saudi Arabia, Tel +966 17 241 1866, Fax +966 17 242 8184, Email mabas@kku.edu.saAbstract: Heart attacks, arrhythmias, and cardiomyopathy are all linked to the 2019 coronavirus disease (COVID-19), which has been identified as a risk factor for cardiovascular disease. Nothing can be held accountable in the current state of affairs. Undiagnosed chronic systolic heart failure (CSHF) develops when the heart’s second half of the cardiac cycle does not function properly. As a result, the heart’s blood pumping function is interrupted. Stress-induced cardiomyopathy may be caused by a variety of factors inside the body (SICM). Cytokine storm and microvascular dysfunction are among the issues. There is inflammation in the heart muscle, which may lead to stress-induced cardiomyopathy. A major part of our study is going to be devoted to understanding the effects of coronavirus on the cardiovascular system and blood vessels. A lot of time and effort has been put into figuring out the health effects of radiation exposure. The heart and circulatory system are shown to be affected by the coronavirus in this research. COVID-19 is shown to influence persons with heart disease, heart failure, arrhythmias, microvascular angiopathy, and cardiac damage in this study.Keywords: coronavirus, heart failure, cardiac diseases, myocardial injury, arrhythmias

Bader S AlQahtani,1– 3 Saeed Alshahrani,1,2 Waleed W Khayyat,4,5 Maram EA Abdalla-Elsayed,6 Abdullah A Altalhi,3,4 Amjad A Saifaldein,7 Mohammed A Taha1,2 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 3Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia; 4College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 5King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia; 6Department of Ophthalmology, Jeddah Eye Hospital, Jeddah, Saudi Arabia; 7Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Saeed AlshahraniCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ar Rimayah, Riyadh 11481, Saudi ArabiaTel +966-53-089- 5550Email saeedalshahrani158@gmail.comPurpose: This study aimed to assess the overall and specific topographic changes among patients who underwent corneal collagen cross-linking (CXL) due to progressive keratoconus.Methods: This retrospective case series study was conducted at a single-arm hospital in King Abdulaziz Medical City, Riyadh. All progressive keratoconus patients who underwent CXL between January 2017 and December 2018 were included consecutively. The epi-off crosslinking technique (Dresden protocol) was applied in all patients. The topographic values were measured preoperatively and 12 months postoperatively. Patients with a history of a previous corneal procedure, corneal trauma, or any corneal scarring were excluded.Results: Among our population (29 eyes of 24 patients), 58.6% of eyes were for male patients, and the mean age of the population was 27.76 ± 4.21 years. Based on the topography results, the mean values of corneal thickness at central 3 mm decreased from 473.45 ± 38 μm to 465.72 ± 41.78 μm following CXL (Z = − 1.93, 95% confidence interval [CI] = 0.048– 0.057, p= 0.053). Clinically significant astigmatism measurements were present in 28 (96.6%) eyes before CXL compared to 26 (89.7%) eyes after CXL. The mean values of astigmatism among the patients were 3.37 ± 2.25 diopters before and 3.67 ± 2.61 diopters after CXL (Z = − 1696, 95% confidence interval [CI] = 0.085– 0.096, p = 0.09). After CXL, the mean values of the front elevation at the apex changed from 33.90 ± 20.13 μm to 36.10 ± 21.09 μm (Z = − 2.792, 95% [CI] = 0.003– 0.006, p = 0.005). The mean values of the back elevation at the apex changed from 68.4 ± 35.66 μm to 69.90 ± 35.89 μm (Z = − 0.934, 95% CI = 0.343– 0.366, p = 0.35).Conclusion: The topographic corneal parameters improved significantly in the patients with corneal ectasia after CXL. These results revealed the safety and efficacy of CXL in stabilizing keratoconus progression among Saudi patients at 1 year of follow-up.Keywords: corneal collagen cross-linking, keratoconus, topography, corneal ectasia

Nada J Farsi,1 Yasser Merdad,2 Mohammed Mirdad,3 Omar Batweel,4 Rawan Badri,5 Hind Alrefai,6 Sultanah Alshahrani,7 Rawan Tayeb,8 Jamila Farsi9 1Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Restorative and Aesthetic Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 3Ministry of Health, Jeddah, Saudi Arabia; 4Ministry of Health, Makkah, Saudi Arabia; 5Department of Periodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 6Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 7Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 8Ministry of Health, Riyadh, Saudi Arabia; 9Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Nada J FarsiDepartment of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80200, Jeddah 21589, Saudi ArabiaTel +966126400000Fax +966126952437Email njfarsi@kau.edu.saPurpose: This study aimed to evaluate oral health knowledge, attitudes, and behaviors among a sample of senior students at King Abdulaziz University (KAU), and to assess differences among these factors between genders.Methods: A total of 1177 senior university students at KAU were included in this cross-sectional study. Participants were selected by stratified random sampling. KAU has three main streams categorized by field of study. One faculty was randomly selected from each stream. Information regarding oral health knowledge, attitudes, and behaviors was collected with a validated self-administered questionnaire. A knowledge score was calculated, and predictors of oral health knowledge were assessed by linear regression.Results: In general, the mean oral health knowledge score of females (8.1 ± 1.8) was significantly higher than that of males (7.2 ± 2.1) out of 13. Relative to males, females reported a greater frequency of teeth cleaning and of using a toothbrush with proper technique (p < 0.001). Females were also more likely to have ever visited a dentist than males (95% and 86%, respectively). The linear regression model revealed that students in non-medical faculties and those who were not shown how to brush their teeth by a dentist had lower oral health knowledge scores, than their counterparts. Students older than 22 years and females were more likely to have higher oral health knowledge scores than were their counterparts.Conclusion: Oral health knowledge was relatively low among the university students, but females showed better oral health knowledge and behaviors than males did.Keywords: oral health, attitudes, behaviors, university students

OBJECTIVE: The aim of this study was to investigate the relationship between organizational characteristics and diabetes care from the perspective of healthcare professionals (HCPs) in Abha, Kingdom of Saudi Arabia. SUBJECTS AND METHODS: A cross-sectional, self-reported survey of healthcare professionals was done. The study comprised a total of 106 HCPs from various departments involved with diabetes patient clinics or service providers. The electronic data collecting form was used to gather the data. RESULTS: The study revealed a stronger association between the availability of bed facilities and better glycemic control. Moreover, the majority of HCPs believes that urbanization and sedentary lifestyles are the main contributors to the rise of diabetes mellitus in Saudi Arabia. Depending on organizational features, the regulations that are available for monitoring defaulter patients and running continuous medical education (CME) programs are vastly different. The main cause of the reported lack of medications for managing diabetic care was described as being a problem with the central medical supply store's drug supply, which was influenced by the type of health sector. CONCLUSIONS: Facilitating change at all levels, including patient education, HCPs education, and organizational development, can improve the quality of treatment. The current study can provide insight into the focus of interventional strategies to deliver diabetes patients with high-quality patient care. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to understand the impact of demographic characteristics and to describe the gender differences in knowledge, beliefs, and attitudes towards bipolar disorders among common residents in the southern region of Saudi Arabia. SUBJECTS AND METHODS: This cross-sectional survey was conducted between January 2021 and March 2021. The survey was conducted among the common residents in the Southern region of the Kingdom of Saudi Arabia. The data were collected by using a structured, self-administered, validated questionnaire comprised of a dichotomous type of questions along with Likert scale. RESULTS: There is a significant difference in the distribution of knowledge scores between male and female study participants (p=0.000). No significant gender differences have been identified in beliefs and attitudes toward bipolar disorder (p=0.229) and in overall score (p=0.159). The traumatic event was reported as the major cause of bipolar disorder. The age group and employment status were found to be the major predictor of knowledge, beliefs, and attitudes about bipolar disorder. CONCLUSIONS: Although the knowledge awareness rate on bipolar disorder is high among public in the Southern region, there is a vast scope for improving it. Education should be disseminated to promote mental health awareness and improve attitudes and beliefs on bipolar disorders and reduce stigma and discrimination against patients with bipolar disorders. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The present study was taken up to evaluate the combination of two drugs in the management of behavioral disorders such as locomotor activity, muscle relaxation, analgesic, and anxiolytic activity. MATERIALS AND METHODS: In the methodology, Wistar rats weighing (150-180 g) were divided into six groups of 6 each (n=6). All the animals (groups II to VI) were subjected to stress and analyzed for anxiolytic activity using an elevated plus maze. The animals were treated for 28 days with poppy seed oil in lower and higher doses (1,000 and 2,000 mg/kg), tramadol in lower and higher doses (1.5 and 3 mg/kg) as individual groups, and one group with a combination of both drugs in lower doses. RESULTS: The results depicted showed that the combined treatment had significantly (**p <0.001) improvised behavior deficits, extemporized, and diminished anxiety-like attitude in rats, and showed the analgesic property in a significant manner. The pro-inflammatory cytokines TNF-a and IL-1ß were evaluated in the serum and were observed to be lessened the values of both in a significant manner with the co-administration of both the test drugs. The dopamine concentrations were also determined in the serum, which disclosed a decline (**p <0.001) significantly. CONCLUSIONS: It was concluded from the results that a combined effect of drugs might be beneficial in the management of behavioral disorders and pain management. [ABSTRACT FROM AUTHOR]

Ramasubbamma Ramaiah,1 Aruna Jothishanmugam,2 Shadia Hamoud Alshahrani,1 Vanitha Innocent Rani,3 Bader Yahya Alshahrani,4 Logapriya Rajagopal Sambasivan,5 Justin Xavier Dhas6 1Medical and Surgical Department, College of Nursing, King Khalid University Abha, Khamis Mushait, Asir, Saudi Arabia; 2Department of Nursing, University College at Aldair, Jazan University, Jazan, Saudi Arabia; 3Psychiatric Nursing Department, Nursing College Mahayil, King Khalid University, Mahayil, Asir, Saudi Arabia; 4Supplies Warehouse Department, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia; 5Biochemistry Department, Government Medical College, Thiruvallur, The TN Dr.MGR Medical University, Thiruvallur, TN, India; 6Artificial Intelligence and Data Science Department, Velammal Institute of Technology, Viraganur, Anna University, TN, IndiaCorrespondence: Ramasubbamma Ramaiah, Email rramaiah@kku.edu.saBackground: The rate of cesarean section is increasing from 15% to 40% in recent years. The type of delivery influences the hormonal, emotional and mental health of the mother, which correlates positively or negatively with the health benefits of the newborn. There have been many published studies on kangaroo mother care for mothers undergoing elective cesarean section, but there is still a lack of understanding about emergency cesarean section.Objective: This study aimed to evaluate the benefits of KMC practice for mothers undergoing emergency cesarean section in terms of hormone levels such as oxytocin, cortisol, prolactin, interleukin-6 and interleukin-10.Methods: This retrospective analysis used remnant serum (KMC group = 16; control group = 9), and clinical data such as KMC practice (15– 30 minutes three or four times daily until discharge), breastfeeding initiation time, feeding time, crying time and hospital stay were extracted from the electronic database. All hormone and cytokine expressions were quantitatively determined by ELISA. Comparisons within and between groups were performed using appropriate statistical tests.Results: In the KMC group, increased levels of the hormone oxytocin significantly reduced cortisol and IL-6 and negatively influenced prolactin and IL-10 levels. The elevated prolactin facilitates overall lactation behaviour, of which 64% reported breastfeeding directly at the breast. The cytokine analysis revealed a reduction in pro-inflammatory cytokines and thereby an improved wound healing was seen in the KMC group.Conclusion: These quantitative results strongly encourage the use of KMC for mothers undergoing emergency cesarean section. These simple yet effective breastfeeding strategies promote maternal and infant health, which can reduce medication use.Keywords: lactation, KMC, nursing strategy, hormone, cytokine

OBJECTIVE: Breast cancer is the most common malignancy in Kingdom of Saudi Arabia (KSA) and an increasing burden in terms of incidence, morbidity and mortality. It accounts for about 28.7% of all new cancers in women. In 2015, the Saudi cancer registry shows that breast cancer was graded first among women and it accounts for 16.7% of all cancers reported among Saudi nationals. This study was designed to assess breast cancer screening knowledge and practices among women in the Asir region, Kingdom of Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study recruiting 1,021 female participants was performed. The variables included breast cancer knowledge, socio-demograph-ic features, breast self-examination knowledge and practice. Descriptive statistics was used to compare and analyze the collected data while chi-square test was used to check the statistical significance among the selected variables. Saudi married women from Asir region were the participants of this cross-sectional study. ReSULTS: Our findings suggested that participants had a satisfactory level of knowledge about breast self-examination and mammo-grams at a rate of > 90% and 44.76% respectively. Over 90% of participants had good breast self-exam knowledge, however, only 6.37% was always performed breast self-examination. Similarly, nearly 40% of participants performed mammograms, while 40.5% were unaware. Leaflets and doctors were the primary sources of information for participants regarding the information of breast cancer screening. CONCLUSIONS: Breast self-examination is a crucial approach to the timely detection of breast cancer and is subsequently critical for effective treatment. From the findings of this study we concluded that most women in the Asir region have a good awareness of breast cancer screening methods. However, either screening of self-examination or mammogram for breast cancer was not carried out thoroughly and regularly. This means that we must continue to emphasize the importance of primary health care in the earliest stages of breast cancer. [ABSTRACT FROM AUTHOR]

Sultan M Alshahrani,1 Amjad Alotaibi,2 Ebtesam Almajed,2 Aisha Alotaibi,2 Kholoud Alotaibi,2 Sara Albisher3 1Department of Neurosciences, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 2College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 3College of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Sultan M Alshahrani, Department of Neurosciences, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Airport Road, Riyadh, 11564, Saudi Arabia, Tel +966-112803212, Fax +966-112800000, Email sumalshahrani@kaauh.edu.saIntroduction: Contracting coronavirus disease (COVID-19) during pregnancy has been linked to an increased risk of severe maternal and fetal complications. Mass vaccination is considered a promising solution to successfully combat the COVID-19 pandemic. It includes vaccinating of pregnant and breastfeeding women. The success of a vaccine is determined not only by its efficacy, but also by its acceptability. Therefore, our study aimed to explore the acceptability and reluctance of pregnant and breastfeeding women to receive COVID-19 vaccination in Saudi Arabia.Methods: This cross-sectional study was conducted in Saudi Arabia from March 2022-beginning to June 2022-end. Using an online self-administered questionnaire with a convenience sampling technique, we assessed women for pregnancy, gravidity, parity, high-risk pregnancy, trimester of pregnancy, and current or planned breastfeeding. Furthermore, we assessed patients with preexisting chronic illnesses. The questionnaire comprised sociodemographic data and items drawn from Goncu Ayhan et al, including vaccination history, perception of risk related to the COVID-19 pandemic, impact of the COVID-19 pandemic, and acceptance and attitude toward future COVID-19 vaccination.Results: A total of 854 women (615 pregnant and 192 breastfeeding women) were included. Predictors of COVID-19 vaccination acceptance were found in women with a high level of education, those who lived with an elderly family member, and had close contact with a COVID-19-positive person. The reasons for declining vaccination included COVID-19 diagnosis during pregnancy and concerns about side effects of COVID-19 vaccines. A total of 503 (58.9%) women believed that COVID-19 vaccines had the potential to harm their babies. Only 415 (48.6%) agreed they would take the COVID-19 vaccine if it were recommended for pregnant women.Conclusion: Pregnant and breastfeeding women fear COVID-19 vaccination due to safety concerns for their babies. COVID-19 vaccine acceptance varies among pregnant and breastfeeding women, regardless of whether they receive the COVID-19 vaccine. Our study underlines the importance of public education campaigns to improve the overall quality of information on COVID-19 vaccination, particularly among pregnant and breastfeeding women.Keywords: COVID-19, fears, vaccine, pregnant, breastfeeding, Saudi women

Sultan M Alshahrani,1 Khalid Orayj,1 Ali M Alqahtani,2 Adel Alfatease,3 Atheer Alshahrani,4 Ahmed RN Ibrahim1,5 1Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Pharmacology Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 3Pharmaceutics Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 4Alnahdi Pharmacies, Khamis Mushait, Saudi Arabia; 5Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, EgyptCorrespondence: Ahmed RN Ibrahim, Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia, Tel +966 554088979, Email aribrahim@kku.edu.saIntroduction: Community pharmacists play a key role as vaccinators for COVID-19. They can reduce the burden of the disease worldwide.Objective: This study used a cross-sectional questionnaire to determine whether the Saudi Arabian public was willing to obtain the COVID-19 vaccine via community pharmacists.Results: The questionnaire focused on the satisfaction, concerns, and opinions towards providing vaccination by community pharmacists. The study featured 415 individuals aged 18 and older (eligible for the COVID-19 vaccine). Of the participants in this study, 58.1% were aged 18– 25, with 55.4% female. Most participants (72.8%) have not been exposed to COVID-19 and are not aware of the approval of COVID-19 vaccination by community pharmacists. Of the 415 complete questionnaires, 45% believed that community pharmacists are not experienced in administering vaccines. However, 63% of participants are satisfied with getting the COVID-19 vaccination by a community pharmacist if no other option is available. More than 68% of the respondents agree that community pharmacies should expand their health care services to include vaccinations, prescriptions, checkups, and other forms of preventative medicine.Discussion: The availability of community pharmacist-administered vaccination in Saudi Arabia could be a significant factor in the success of the country’s vaccination program. This study may serve as a model to expand the role of pharmacists in other countries’ vaccination programs.Keywords: SARS-CoV-2, community pharmacy, immunization, perspective, adherence, patient satisfaction

Dodonaea viscosa (Sapindaceae) was collected from Riyadh, Saudi Arabia. For the simultaneous measurement of quercetin and kaempferol, a validated high-performance thin-layer chromatography (HPTLC) approach was devised in D. viscosa leaf extract. The antioxidant activity was evaluated using diphenyl 1-picrylhydrazyl (DPPH) and 2,2′-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) assays. Moreover, the cytotoxic effect was tested against three cancer cell lines A549, HepG2, and MDA-MB-231. The potential anti-inflammatory properties of different fractions of D. viscosa were also evaluated using lipopolysaccharide (LPS)-induced THP-1 macrophages cells. The test samples include a crude extract of leaves and its solvent-soluble fractions of D. viscosa. The results showed that the crude extract and its fractions exhibited various significant biological activities, the fraction of chloroform demonstrated the highest free radical scavenging activity with IC50 values: 172.2 and 257.7 µg/mL for both DPPH and ABTS tests. Additionally, the chloroform fraction had the greatest cytotoxic activity against MDA-MB-231 (IC50 values: 24.6 ± 0.4 µg/mL). Moreover, the chloroform fraction exhibited the highest downregulation of the LPS-induced expression of TNF-α and IL-6. Quercetin and kaempferol were estimated concurrently in leaves crude extract using a validated technique on an HPTLC plate (10 cm2 × 10 cm2) with a combination of toluene–ethyl acetate–formic acid (5:4:0.2; v/v/v) as the mobile phase and a λ max of 254 nm. The amount of quercetin and kaempferol was found to be 31.8 and 15.01 mg/g of dried leaf extract, respectively. The presence of high levels of quercetin and kaempferol in D. viscosa leaves extract could explain its remarkable antioxidant, cytotoxic, and anti-inflammatory effects. The devolved HPTLC method can be used for routine analysis and standardization of D. viscosa crude plant material, extracts, and/or finished products using quercetin and kaempferol as appropriate markers.

Gaffar Sarwar Zaman,1 Safar Abadi Saeed Al-Saleem Alshahrani,2 Nasrin Banu Laskar,3 Ibrahim Hadadi,4 Magbool Alelyani,4 Mohamed Adam,4 Mohammed Babiker,5 Mustafa Jafar Musa,6 Pranab Barua,7 Mohammed Elimam Ahamed Mohammed8 1Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia; 2Family & Community Department, College of Medicine, King Khalid University, Abha, Saudi Arabia; 3Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim, India; 4Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia; 5Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha, Saudi Arabia; 6Department of Radiology, College of Applied Medical Sciences, Jeddah University, Jeddah, Saudi Arabia; 7Department of Statistics, J.B. College, Jorhat, Assam, India; 8Department of Chemistry, Faculty of Science, King Khalid University, Abha, Saudi ArabiaCorrespondence: Gaffar Sarwar ZamanDepartment of Clinical Laboratory Sciences, College of Applied,Medical Sciences, King Khalid University, P.O. Box: 960, Abha, 61421, Saudi Arabia, Tel +966 509228143, Email drgszaman@gmail.comPurpose: This research examined the association of cigarette smoking and altitude with the blood levels of 25-hydroxy vitamin D, testosterone and carotid artery thickness.Patients and methods: This comparative cross-sectional study involved 37 non-smokers and 24 smokers from a high-altitude area (≥ 2245 m above sea level) and 40 smokers and 40 non-smokers from a low-altitude area (39– 283 m above sea level). The blood testosterone level was determined spectrophotometrically, and the 25-hydroxy vitamin D concentration was measured by ELISA. The IMT of the right and left carotid arteries was determined using ultrasound imaging.Results: Smoking notably elevated the thickness of the intima media of the right and left carotid arteries at both high and low altitudes (p ≤ 0.001). Smoking at high altitude was associated with a significant increase in the concentration of 25-hydroxy vitamin D and testosterone, while at low altitude it was associated with a significant decrease in both parameters (p ≤ 0.046).Conclusion: These contrasting results suggest that future studies should focus on finding out if other biochemical parameters show any significant differences in smokers or/and non-smokers when they are tested at elevated height and sea-level. This indicates that dose modifications of medicines (related to alterations in vitamin D and testosterone levels) should be kept in mind while treating smokers and non-smokers at elevated height above sea level.Keywords: altitude, smoking, aging, body mass index, intima media thickness

Mohammad Saeed Al-Shahrani,1,2 Faisal Ahmad Katbi,1,2 Abdulaziz Mohammad Al-Sharydah,3 Saad Dhafer AlShahrani,4 Talal Mosfer Alghamdi,5 Mohammad Adnan Al-Sharidah1 1Department of Emergency, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar City, Eastern Province, Saudi Arabia; 2Department of Critical Care, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar City, Eastern Province, Saudi Arabia; 3Department of Diagnostic and Interventional Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar City, Eastern Province, Saudi Arabia; 4Department of Emergency, Royal Commission Hospital, Jubail City, Eastern Province, Saudi Arabia; 5Department of Anesthesia, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar City, Eastern Province, Saudi ArabiaCorrespondence: Mohammad Saeed Al-Shahrani Email msshahrani@iau.edu.saPurpose: Acute coronary syndrome (ACS) is a life-threatening cardiac disease identified by acute, regional reductions in coronary blood flow, resulting in myocardial ischemia, or infarction, and manifesting as discomfort in the chest area, neck, or arms. Frequently, ACS is provoked by an atherosclerotic plaque; therefore, coronary atherosclerosis is converted into a chronic disease to an acute medical emergency. The purpose of this study was to explore the differences among these variables in patients less than 45 years of age suffering from this major health problem compared to older adults admitted with an ACS diagnosis, and to adopt an optimized temporary management.Patients and Methods: A retrospective chart review study was conducted on a total of 652 ACS patients admitted at King Fahad Hospital of the University (KFHU) between 2015 and 2020. The patients’ medical records were utilized for obtaining demographic data, presenting symptoms, risk factors, and clinical outcomes.Results: Overall, 652 patients were enrolled. Of these, 109 patients (16.7%) were under 45, with a mean age of 38 ± 7. Younger patients showed a higher rate of palpitation (23.9% versus. 13.6%; P = 0.019). A positive smoking history and a family history of CAD were seen more often in younger patients (42.2% vs 27.3%, P < 0.001; 22.9% vs 9.4%, P < 0.001, respectively). Older patients had greater renal impairment with higher creatinine (median = 1.10 mg/dl (range, 0.3– 13.0) vs 1.0 (0.3– 19.0; p = 0. 001), BUN (median = 16.0 (mange, 0.9– 141.0) vs 12.0 (0.9– 49.0); P < 0.001)). Younger patients had higher levels of LDL and total cholesterol (median 138c. 115; p < 0.001) and cholesterol (median 209 vs 178.5; p < 0.001). Hospital mortality was 0.9% in younger patients versus 7.4% in older patients (P = 0.004).Conclusion: Palpitations, smoking, family history, higher LDL levels, and total cholesterol levels were more prevalent in adults younger than 45 years old with ACS. Impaired renal function, hypertension, and diabetes were more in older patients with ACS.Keywords: acute coronary syndrome, young adults, clinical features, in-hospital outcome

Adel Alfatease,1 Ali M Alqahtani,2 Khalid Orayj,3 Sultan M Alshahrani3 1Pharmaceutics Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Pharmacology Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 3Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi ArabiaCorrespondence: Sultan M AlshahraniClinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, 61441, Saudi ArabiaTel +966 508747473Email shahrani@kku.edu.saIntroduction: Social media platforms are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination.Purpose: The objective of this study is to understand the influence of social media on the attitudes and willingness of the general public of the Aseer region of Saudi Arabia to receive COVID-19 vaccination.Materials and Methods: A cross-sectional self-administrated online survey was conducted in Saudi Arabia Aseer region, where 613 persons willingly took part in the survey in April and May 2021. Residents of Aseer in Saudi Arabia, who are over the age of 18 (eligible for COVID-19 vaccination) and willing to participate in the survey, were included in the study.Results: Overall, 74.6% agreed that the COVID-19 vaccine was misrepresented via social media. However, 37% of those respondents strongly agreed that social media had increased their willingness to get the COVID-19 vaccine. In addition, employees reported (21.8%) or strongly agreed (28%) that the quantity and quality of information on social media has a detrimental impact on their psychological well-being. Additionally, participants also agreed (21.8%) or strongly agreed (28%) that social media had a negative effect on their psychological condition.Conclusion: The study provides that there was a high degree of awareness indicated among Aseer population regarding misleading information about COVID-19 vaccination via social media. Thus, social media that can share up-to-date scientific information about vaccination must be utilized optimally by the government to assist people in making decisions about accepting vaccinations.Keywords: social media, COVID-19, vaccination, survey, Saudi Arabia

Sultan M Alshahrani College of Pharmacy, King Khalid University, Abha, Saudi ArabiaCorrespondence: Sultan M AlshahraniCollege of Pharmacy, King Khalid University, Abha, Saudi ArabiaTel +966 508747473Email shahrani@kku.edu.saPurpose: This study investigated the knowledge, attitudes, and practice of community pharmacists regarding weight reduction products in Aseer region, Saudi Arabia.Materials and Methods: A questionnaire-based study of community pharmacists in Aseer region, Saudi Arabia, was conducted between March and May 2019.Results: The most commonly prescribed weight reduction agent was green tea followed by oatmeal products and ginseng. The results revealed that almost 85% of the respondents did not know which weight reduction agents are approved as over-the-counter products by the US Food and Drug Administration. Community pharmacists had positive attitudes toward the safety and efficacy of weight reduction products, but 64.91% indicated that they would limit weight reduction agents to obese patients who could not reduce their weight through exercise and diet. More than 80% of the participants agreed that it is very important to counsel patients regarding weight reduction products, and more than 80% also agreed that pharmacists should regularly discuss weight reduction products with other healthcare professionals.Conclusion: Community pharmacists showed positive attitudes and efficient practice towards prescribing weight reducing products. However, there was a deficit regarding the knowledge about which products approved by FDA to manage overweight. That requires to consolidate the role of community pharmacists in weight management in Saudi Arabia with more continuous education and regulation.Keywords: weight, community pharmacists, obesity, survey, Saudi Arabia

Sultan M Alshahrani,1 Sirajudeen Shaik Alavudeen,1 Khaled M Alakhali,1,2 Yaser Mohammed Al-Worafi,3 Ahmed K Bahamdan,1 Easwaran Vigneshwaran1 1Clinical Pharmacy Department, College of Pharmacy, King Khalid University, Abha, Saudi Arabia; 2Clinical Pharmacy Department, College of Pharmacy, USCI University, Kuala Lumpur, Malaysia; 3Clinical Pharmacy Department, College Of Pharmacy, University of Science and Technology of Fujairah, Fujairah, UAECorrespondence: Yaser Mohammed Al-WorafiCollege of Pharmacy, University of Science And Technology of Fujairah, Fujairah, UAETel +971543041178Email yworafi@yahoo.comPurpose: This study objective was to explore the pattern of self-medications among King Khalid University students, Saudi Arabia.Patients and methods: A cross-sectional study was conducted over five months among King Khalid University students, Abha, Saudi Arabia.Results: Among all the study participants, nearly 98.7% were practicing self-medication. Headache (75.9%), cough and cold (52.5%), and fever (35.6%) and body pain (24.6%) were the most reported symptoms. Use of painkillers (91.6%) was significantly predominant among the medical students, whereas non-medical students used antibiotics (35.4%).Time saving (64.2%), mild symptom (51.7%) and quick relief (36.9%) were the reasons behind seeking self-medication in this study.Conclusion: Self-medications was common in King Khalid University. Educational programs are highly recommended.Keywords: self-medication, students, medical, nonmedical, King Khalid University, Saudi Arabia

Bayan A Alsaif,1 Mohanna Y Aljindan,2 Hanan M Alrammah,1 Malak O Almulla,1 Saad S Alshahrani3 1College of Medicine, King Fahad Hospital of the University, Imam Abdulrahamn Bin Fasial University, Khobar, Saudi Arabia; 2Department of Ophthalmology, King Fahad Hospital of the University, Imam Abdulrahman Bin Fasial University, Khobar, Saudi Arabia; 3Epidemiology Department, King Fahd Specialist Hospital, Dammam, Saudi Arabia Objectives: To determine the prevalence of refractive errors among freshman students of Imam Abdulrahman Bin Faisal University (IAU), and to examine the relationship of near-work activities and outdoor activities with refractive errors. Methods: A cross-sectional study of 338 freshman students of IAU (162 males, 176 females) was carried out. Students were selected using a simple random sampling technique. Eye examination was done including non-cycloplegic autorefraction for determining the refractive error status. Myopia was defined as spherical equivalent refraction (SER) ≤-0.75 diopters (D), and it was further divided into low myopia (SER from -0.75 D to -2.99 D), moderate myopia (SER from -3.00 to -5.99 D), and high myopia (SER ≤-6.00 D). Hyperopia was defined as SER ≥1.00 D and emmetropia as having an SER value between that of low myopia and hyperopia. SER was calculated as sphere + 1/2 cylinder. A questionnaire detailed on activities was completed by participants. Results: Myopia was found in 47.9% of the students (95% CI 42.7%–53.3%). The most prevalent type of myopia was low myopia (66.7%; 95% CI 59.1%–73.5%). Hyperopia and emmetropia were found in 6.5% (95% CI 4.3%–9.7%) and 45.6% (95% CI 40.3%–50.9%) of the students, respectively. Parental myopia was significantly associated with the myopic status of the students (P=0.007, Fisher’s exact test). About 6% of myopic students had a history of myopia in both parents. In addition, both parents had a history of myopia in 1.9% of emmetropic students, whereas such an association was absent in the hyperopic students. Refractive error type in both genders was not significantly predicted by the activity type. Conclusion: Although the different types of activities did not predict the types of refractive errors, the high prevalence of myopia among the college students at this age requires further studies to explore more about the clinical characteristics and risk factors of the disease. Keywords: near-work, outdoor activity, college students, axial length, keratometry, anterior chamber depth, myopia, biometry

In the current study, silver nanoparticles (AgNPs) were biosynthesised by microwave irradiation using Azadirachta indica. The formation of AgNPs was confirmed by surface plasmon resonance (SPR) band at 408 nm at UV-visible spectroscopy due to reduction of silver metal into (AgNPs) and further confirmed its particles in nano range. Nine different smart-gel hand wash were prepared by dispersing (AgNPs) in the HPMC and/or Pluronic F-127 polymers. The prepared smart gel hand wash was optimized based on pH, viscosity, spreadability, foamability, clarity. The optimized hand wash (NH5) had pH (6.6 ± 0.33), viscosity (66 ± 0.77, cp), spreadability (24.34 g-cm/s), foamability (100 mL). The optimized hand wash (NH5) showed a superior efficacy against pathogenic organisms in comparison to germ protection based marketed hand wash.

Saeed T Alshahrani,1 Nicola G Ghazi,2 Saba Al-Rashaed2 1Ophthalmology Department, King Fahad Specialist Hospital, Dammam, 2Vitreoretinal Department, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia Purpose: To investigate the clinical findings and outcomes of rhegmatogenous retinal detachment (RRD) in Stickler syndrome on affected and fellow eyes that underwent prophylactic retinopexy.Patients and methods: Chart review of 70 eyes (62 patients). Incidence of RRD, postoperative visual acuity, and risk factors were evaluated.Results: Twenty-two patients (35%) had RRD in the fellow eye, 37% of the eyes had cataract, 93% had macular detachment, 50% had proliferative vitreoretinopathy, and 41% had posterior vitreous detachment. Success rates were: 60% of patients after scleral buckling; 57.1% after pars plana vitrectomy; and 75% after combined scleral buckling and pars plana vitrectomy. Sixty-one (93.8%) of patients had successful surgery (including second surgery). Silicone oil tamponade was significantly associated with final anatomic outcome, with a protective odds ratio of 0.11 (P=0.027). Visual acuity improved in 54% of eyes and decreased in 5%. Statistically significant associations were present for eyes with final visual acuity ≥20/200, and total retinal detachment (P

Saeed T Alshahrani,1,2 Hanan N Al Shamsi,2 Eman S Kahtani,2 Nicola G Ghazi2,3 1King Fahad Specialist Hospital, Dammam, Saudi Arabia; 2King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 3University of Virginia, Department of Ophthalmology, Charlottesville, VA, USA Purpose: To report spectral-domain optical coherence tomography (SD-OCT) findings in polypoidal choroidal vasculopathy (PCV).Patients and methods: Seventeen eyes of 15 consecutive patients diagnosed with PCV based on typical clinical and angiographic findings were imaged with macular SD-OCT including line scans passing through the polyps.Results: SD-OCT findings included typical and atypical retinal pigment epithelial (RPE) detachments and subretinal and intraretinal fluid in all eyes. In the areas corresponding to the polypoidal lesions, well-delineated round-oval, sub-RPE cavities were present and were adherent to the posterior surface of the detached RPE above Bruch membrane. No retinal or choroidal connections to the cavities were noted.Conclusion: These SD-OCT findings document that the vascular lesions in PCV are not located in the inner choroid, but in the sub-RPE space, suggesting that PCV is a variant of type 1 choroidal neovascularization rather than a distinct clinical entity as initially thought. Keywords: choroidal neovascularization, retinal pigment epithelial detachments, vascular lesion, SD-OCT, type 1 choroidal neovascularization