Examining the Effects of Social Media on Mental Health Among Adolescents in Saudi Arabia.

BACKGROUND: Adolescents are immersed in a highly advanced technology setting, characterized by extensive availability of personal devices, the internet, and other social media platforms, which greatly impact their mental development. Concerns arise around potential negative consequences, including social isolation, internet addiction, exposure to improper content, depression, cyberbullying, and sleeping difficulty. The impact of social media on the mental well-being of adolescents has emerged as an escalating concern. The continuous exposure to carefully selected content, online harassment, and the expectation to comply with unrealistic standards all contribute to the development of depression and anxiety. This research aims to explore the impact of social media on the mental health of adolescents in the Saudi Arabian context. METHODS: This online cross-sectional study was conducted on Saudis aged 10 to 24 years old who have social media accounts in Saudi Arabia between August and November 2023. Binary logistic regression analysis was conducted to identify factors that make the study participants more likely to be mentally affected by social media. RESULTS: A total of 2856 participants were involved in this study. The most commonly used social media platform by the study participants was Twitter (30.3%). The majority of the study participants (77.4%) reported that they have tried to reduce their social media usage for mental health reasons. The most commonly agreed-upon statements were that "they feel that excessive social media use has negatively affected their sleep patterns," "they often sleep late in the night because of social media usage," and "they check their social media account before they sleep in the night," accounting for 71.0%, 66.1%, and 58.3%, respectively. Overall, the study participants showed a low level of being mentally affected due to social media with a mean score of 7.8 (SD: 3.9) out of 21, which is equal to 37.1%. Older participants (aged 16-24 years) were more prone to be mentally affected due to social media compared to younger ones (aged 10-15 years; p < 0.05). On the other hand, participants who were married, had a middle school education level, or lived in the northern, western, or eastern regions were less likely to be mentally affected due to social media compared to others (p < 0.05). CONCLUSION: The study participants showed a low level of being mentally affected due to social media. Individuals in the 16-24 years age group show a higher susceptibility to mental impacts resulting from social media usage. The primary duty for reducing the potential negative effects of social media should not rest only on parents and caregivers. Advocating for the creation of technology-free zones and fostering in-person friendships among teens could be a beneficial approach that policymakers should support.

Physicians' Knowledge of the Systematic ABCDE Approach in Riyadh, Saudi Arabia.

Purpose: To evaluate physicians' knowledge of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach components. Methods: A cross-sectional study was conducted in 2023 using an online questionnaire in order to collect data about the knowledge of the ABCDE approach's components among physicians in different specialties in Riyadh, Saudi Arabia. Results: The number of participants were 165 in total and the median knowledge score for all participants was 15.0, with an associated interquartile range (IQR) of 10.0 to 20.0. Intensive Care Medicine had the highest median knowledge score of 19.0 (IQR: 12.0-21.0), followed by Internal Medicine at 17.0 (IQR: 13.0-20.0). Conversely, Cardiology and Anesthesiology showed lower scores, with medians of 8.0 (IQR: 4.0-10.0) and 7.5 (IQR: 4.0-13.5), respectively (p = 0.011). Senior Registrars demonstrated the highest median knowledge score of 20.0 (IQR: 14.0-22.0), while Fellows had the lowest at 8.5 (IQR: 7.0-13.0) (p < 0.001). Practicing for 10 to 15 years and more than 15 years having medians of 20.0 (IQR: 16.0-23.0) and 19.0 (IQR: 17.0-22.0), respectively. However, participants with less experience, working for less than 5 years, had a median score of 12.0 (IQR: 8.5-16.5) (p < 0.001). Conclusion: Knowledge scores of physicians representing various medical specialties found diverse levels regarding the ABCDE approach. Knowledge scores were significantly influenced by the primary area of practice, level of experience, and duration worked in the profession, highlighting the need for tailored training and education across different specialties and career stages. On the other hand, future studies should concentrate on finding new factors that influence practice adherence to the ABCDE approach and tying theoretical knowledge to clinical practice.

Knowledge, Attitudes, and Practice Patterns of Lung Cancer Screening Among Physicians in Saudi Arabia.

BACKGROUND: Lung cancer remains the primary cause of death connected to cancer on a worldwide scale. Obtaining a deep understanding of the knowledge, attitudes, and behavior patterns of doctors is essential for developing successful strategies to improve lung cancer screening. This study aims to identify the attitudes, beliefs, referral practices, and knowledge of lung cancer screening among physicians in Saudi Arabia. METHODS: An online survey was conducted from July to December 2023 to investigate the attitudes, beliefs, referral practices, and knowledge of lung cancer screening, and adherence to lung cancer screening recommendations among physicians in Saudi Arabia. Internal medicine, family medicine, and pulmonology physicians of all levels (consultants, senior registrars, and residents) who are currently practicing medicine in Saudi Arabia formed the study population. This study employed a previously developed questionnaire. Binary logistic regression analysis was employed to identify factors that indicate a better degree of knowledge and a positive attitude toward lung cancer screening. RESULTS: This study involved a total of 96 physicians. The study participants demonstrated a significant degree of understanding regarding lung cancer screening, with an average knowledge score of 5.8 (SD: 1.7) out of 8, equivalent to 72.5% of the highest possible score. The accuracy rate for knowledge items varied from 44.8% to 91.7%. The study participants had a moderately favorable attitude toward lung cancer screening, as shown by a mean attitude score of 14.4 (SD: 3.7) out of a maximum possible score of 30, which corresponds to 48.0% of the highest achievable score. Around 36.5% of the survey participants reported engaging in the practice of discussing the results of lung cancer screening with patients. The primary obstacles frequently cited were challenges in patient scheduling, insufficient time to discuss lung cancer screening during clinic appointments, and patient refusal, constituting 59.4%, 53.1%, and 53.1% of the identified barriers, respectively. Physicians in Saudi Arabia, particularly those employed in private hospitals, demonstrated a higher level of knowledge of lung cancer screening compared to others (p < 0.05). In contrast, individuals with 11-15 years of experience were shown to have a 78.0% lower likelihood of being educated about lung cancer screening compared to their counterparts (p < 0.05). CONCLUSION: The study's results indicate that there is a need for the development of specialized educational initiatives aimed at Saudi Arabian physicians, particularly those with 11 to 15 years of experience who exhibit a limited understanding of lung cancer screening. Utilizing programs that provide continuing medical education would aid in their education. There is a need to facilitate communication between physicians and patients. It is critical to address the identified issues, such as streamlining the appointment scheduling process and ensuring patients have sufficient time during clinic visits. Furthermore, it is critical for the success of nationwide screening initiatives to foster collaboration between the public and private healthcare sectors.

Attitude, Practices, and Barriers to Menopausal Hormone Therapy Among Physicians in Saudi Arabia.

BACKGROUND: To guarantee the delivery of thorough and scientifically supported menopausal care, it is imperative to allocate resources towards ongoing education and training for physicians. Therefore, it is essential to assess the attitudes, practices, and obstacles faced by physicians in Saudi Arabia when it comes to menopausal hormone replacement therapy (HRT). METHOD: An online survey was conducted from June to September 2023 to investigate the attitudes, practices, and barriers of physicians in Saudi Arabia, regarding menopausal HRT. The study population consisted of practicing physicians in Saudi Arabia specializing in gynecology, endocrinology, family medicine, internal medicine, and general practice at various levels, including consultants, senior registrars, and residents. The survey link was distributed to the intended research participants in Saudi Arabia using several social media platforms (Facebook, Twitter, Snapchat, WhatsApp, and Instagram) utilizing a Google Form hyperlink. RESULTS: A total of 95 physicians participated in this study. A total of 60.0% of the study participants agreed that in general, HRT should be offered to menopausal women who have menopausal symptoms. Besides, around 24.2% of them agreed that in general, HRT should be offered to menopausal women who do not have menopausal symptoms. The most commonly reported methods of obtaining up-to-date information about HRT were Ministry of Health in Saudi Arabia publication and journal articles, contributing 36.8% (n=35) and 24.2% (n=23), respectively. The most commonly reported type of systemic (i.e. non-vaginal) HRT for women with premature menopause (menopause <40 years) without contraindications was combined oral contraceptive pill accounting for 33.7% (n=32). More than half of the study participants (53.6%; n=51) reported experiencing difficulty or barriers related to prescribing HRT. The most commonly reported difficulties and barriers related to HRT prescribing were consumer preferences for complementary/alternative therapies, difficulty explaining HRT risks and benefits to women, and lack of suitable HRT products accounting for 27.4% (n=26), 21.1% (n=20), and 16.8% (n=16), respectively. CONCLUSION: The nuanced perspectives of Saudi Arabian physicians regarding HRT for postmenopausal women are revealed in this study. Electronic published societal guidelines and Ministry of Health publications are examples of vital information resources that physicians must have access to. Difficulties associated with the prescription of HRT, including product shortages and consumer preferences, underscore the criticality of confronting obstacles in clinical practice. Additional investigation is suggested in order to enhance physicians' knowledge and implementation of guidelines, specifically for patient cohorts whose medical histories are unique.

Knowledge and Attitude of Parents Regarding the Human Papillomavirus Vaccine as a New Component in the Saudi Vaccination Schedule.

Background The most frequent gynecologic cancer in women is cervical cancer. The majority of incidents take place in less developed nations without access to reliable screening tools. Human papillomavirus (HPV) exposure, smoking, and immune system dysfunction are risk factors. As a result of effective screening, its incidence and death have significantly decreased in many nations. Hence, this study aims to assess the level of knowledge and awareness among parents regarding HPV, including its associated health risks and the benefits of vaccination. Methodology A descriptive cross-sectional study was carried out in the Riyadh region of Saudi Arabia from September to November 2023. The main tool used for gathering data was an online, self-administered survey via Google Forms. Collected data was analysed using SPSS v. 24 (IBM Corp., Armonk, NY), where all applicable statistical tests were used. Results Females exhibited higher levels of confidence and agreement with COVID-19 and HPV vaccination recommendations compared to males. A substantial percentage of males expressed strong disagreement and reduced confidence in HPV vaccination, contributing to the gender-based divergence. Individuals with higher education levels, such as university degree graduates, showed greater support for compulsory vaccines and a preference for natural immunity development in their children. Marital status played a role in vaccine-related decisions, with variations in vaccine refusal rates and difficulty discussing the HPV vaccine noted among individuals based on their marital status. Conclusion The study highlights the value of medical experts and specifically created training programs to close knowledge gaps and boost HPV vaccination rates. Demographic factors have an impact on attitudes, which highlights the need for targeted interventions.

Knowledge and Awareness About Risk Factors, Clinical Manifestations, and Prevention of Thyroid Disorders in the Era of COVID-19 and Their Association With Socioeconomic Status Among the General Population in Riyadh, Saudi Arabia.

Background Thyroid dysfunction represents the most commonly observed endocrine illness within the population of Saudi Arabia. Thyroid cancer has been recognized as the second most commonly occurring malignant neoplasm among women in Saudi Arabia. Furthermore, there is evidence suggesting that COVID-19 and, to a certain degree, immunization may have an impact on thyroid function. The aim of this study was to evaluate the level of public knowledge, awareness, and attitudes pertaining to the manifestations and risk factors of thyroid disease. Additionally, the study sought to examine the potential role of COVID-19 as a risk factor and explore preventive measures in the context of Riyadh, Saudi Arabia. Methods A cross-sectional online survey was conducted targeting the Saudi population living in Riyadh aged 18 years and older. A self-administered questionnaire constructed on Google Forms was distributed to the general population using an online platform. The questionnaire consisted of five sections: demographic data, risk factors for thyroid disorders, clinical manifestations, prevention, and history of thyroid disease. Binary logistic regression analysis was used to identify predictors of better knowledge of thyroid diseases.  Results Among the 693 participants enrolled, 57.7% were female, and 31.7% were aged between 18 and 25 years. The overall mean knowledge score was 12.2 (SD = 6.57) out of 23 points. Poor knowledge of the risk factors, clinical manifestations, and prevention was observed in 50.4% of the participants. A total of 27.6% had moderate knowledge, and 22.1% had good knowledge levels. Furthermore, only 33.9% of the participants believed that COVID-19 infection was a risk factor. The results of the binary logistic regression analysis revealed that individuals within the age range of 36-45 years, females, and students had a significantly higher level of knowledge compared to other participants (p<0.05). Conclusion This study revealed that the general population of Riyadh, Saudi Arabia, lacked adequate knowledge, awareness, and attitudes regarding the risk factors, clinical symptoms, and prevention of thyroid problems. However, middle-aged individuals, females, and those who were enrolled as students showed a higher level of knowledge. Regarding the pathogenesis of COVID-19, it was observed that all participants had a limited understanding and a lack of awareness. Insufficient public awareness may result in misunderstandings, insufficient identification, and potential oversight of COVID-19-infected patients with thyroid dysfunction. Therefore, it is imperative that healthcare authorities intensify their efforts to broaden the dissemination of information throughout the population.

Public Awareness Regarding Corticosteroid Use and Side Effects: A Cross-Sectional Study in Riyadh, Saudi Arabia.

The administration of corticosteroids may have possible hazards, ranging from minor adverse medication reactions to more serious considerations. We aimed to assess levels of public awareness concerning corticosteroid use, side effects, and predictors of its use. A cross-sectional study was conducted online throughout the period of May to July 2023. The present investigation utilized a previously developed questionnaire tool. The study encompassed a cohort of 732 individuals. Upon inquiry regarding the adverse effects of corticosteroid treatment, the participants predominantly reported weight gain, skin alterations, and fluid retention leading to breathing difficulties, constituting 44.4%, 30.3%, and 27.7% of the responses, respectively. The prevailing adverse effects observed in individuals using corticosteroids were weight gain, alterations in mood, and changes in skin characteristics, which accounted for 38.1%, 25.7%, and 21.8% of reported cases, respectively. Individuals within the age range of 41-50 years and those who are currently not working show a higher propensity for utilizing corticosteroids in comparison to other demographic groups (p < 0.05). The level of general public knowledge about corticosteroids and the side effects connected with them in Saudi Arabia was adequate. Demographic factors, such as age, gender, and education, have an impact on the use of corticosteroids.

Optimization of Bromocriptine-Mesylate-Loaded Polycaprolactone Nanoparticles Coated with Chitosan for Nose-to-Brain Delivery: In Vitro and In Vivo Studies.

Bromocriptine mesylate (BM), primarily ergocryptine, is a dopamine agonist derived from ergot alkaloids. This study aimed to formulate chitosan (CS)-coated poly ε-caprolactone nanoparticles (PCL NPs) loaded with BM for direct targeting to the brain via the nasal route. PCL NPs were optimized using response surface methodology and a Box-Behnken factorial design. Independent formulation parameters for nanoparticle attributes, including PCL payload (A), D-α-tocopherol polyethylene glycol 1000 succinate (TPGS) concentration (B), and sonication time (C), were investigated. The dependent variables were nanoparticle size (Y1), zeta potential (Y2), entrapment efficiency (EE; Y3), and drug release rate (Y4). The optimal formulation for BM-PCL NPs was determined to be 50 mg PCL load, 0.0865% TPGS concentration, and 8 min sonication time, resulting in nanoparticles with a size of 296 ± 2.9 nm having a zeta potential of -16.2 ± 3.8 mV, an EE of 90.7 ± 1.9%, and a zero-order release rate of 2.6 ± 1.3%/min. The optimized BM-PCL NPs were then coated with CS at varying concentrations (0.25, 0.5, and 1%) to enhance their effect. The CS-PCL NPs exhibited different particle sizes and zeta potentials depending on the CS concentration used. The highest EE (88%) and drug load (DL; 5.5%) were observed for the optimized BM-CS-PCL NPs coated with 0.25% CS. The BM-CS-PCL NPs displayed a biphasic release pattern, with an initial rapid drug release lasting for 2 h, followed by a sustained release for up to 48 h. The 0.25% CS-coated BM-CS-PCL NPs showed a high level of permeation across the goat nasal mucosa, with reasonable mucoadhesive strength. These findings suggested that the optimized 0.25% CS-coated BM-CS-PCL NPs hold promise for successful nasal delivery, thereby improving the therapeutic efficacy of BM.

The Perspective of the General Population in Saudi Arabia towards Do-Not-Resuscitate (DNR) Orders: A Cross-Sectional Study.

OBJECTIVES: In the event of cardiac arrest, cardiopulmonary resuscitation (CPR) is an emergency procedure used to maintain the heart and lungs functional simultaneously. The do-not-resuscitate (DNR) order prohibits CPR and is therefore legally required. Despite this, a DNR remains a delicate and contentious issue that places physicians in morally ambiguous situations. This study aimed to assess Saudi citizens' understanding of DNR orders, prior exposure to them, and preferences for DNR conversations. METHODS: This was an online cross-sectional study that was conducted between January and April 2023 and aimed to assess the knowledge regarding DNR orders among Saudi populations. This study adapted a previously developed questionnaire tool by Al Ahmadi et al., which examined the knowledge and attitude toward do-not-resuscitate among patients and their relatives visiting outpatient clinics. Binary logistic regression analysis was the mean knowledge score for the study participants. RESULTS: A total of 920 participants were involved in this study. Almost half of the study participants (49.6%) reported that they had heard of DNR before. The most commonly reported source of their information on DNR was healthcare providers (58.2%). The mean knowledge score of the study participants was 1.9 (1.3) out of 6, which is equal to 31.7% of the total maximum score. This demonstrates the weak level of knowledge about DNR among the general public. Females, divorced, and those who had a post-graduate level of education were more likely to be knowledgeable of DNR compared to others (p < 0.05). Around one-quarter of the study participants showed agreement with DNR. More than half of them (59.5%) believe that physicians should be involved in DNR decision making. CONCLUSIONS: Saudi Arabia's general community has limited knowledge of DNR. It is recommended that healthcare professionals increase patients' and caregivers' understanding of this concept. This will improve the planning and the provision of end-of-life care.

Proposal and Numerical Analysis of Organic/Sb2Se3 All-Thin-Film Tandem Solar Cell.

The low bandgap antimony selenide (Sb2Se3) and wide bandgap organic solar cell (OSC) can be considered suitable bottom and top subcells for use in tandem solar cells. Some properties of these complementary candidates are their non-toxicity and cost-affordability. In this current simulation study, a two-terminal organic/Sb2Se3 thin-film tandem is proposed and designed through TCAD device simulations. To validate the device simulator platform, two solar cells were selected for tandem design, and their experimental data were chosen for calibrating the models and parameters utilized in the simulations. The initial OSC has an active blend layer, whose optical bandgap is 1.72 eV, while the initial Sb2Se3 cell has a bandgap energy of 1.23 eV. The structures of the initial standalone top and bottom cells are ITO/PEDOT:PSS/DR3TSBDT:PC71BM/PFN/Al, and FTO/CdS/Sb2Se3/Spiro-OMeTAD/Au, while the recorded efficiencies of these individual cells are about 9.45% and 7.89%, respectively. The selected OSC employs polymer-based carrier transport layers, specifically PEDOT:PSS, an inherently conductive polymer, as an HTL, and PFN, a semiconducting polymer, as an ETL. The simulation is performed on the connected initial cells for two cases. The first case is for inverted (p-i-n)/(p-i-n) cells and the second is for the conventional (n-i-p)/(n-i-p) configuration. Both tandems are investigated in terms of the most important layer materials and parameters. After designing the current matching condition, the tandem PCEs are boosted to 21.52% and 19.14% for the inverted and conventional tandem cells, respectively. All TCAD device simulations are made by employing the Atlas device simulator given an illumination of AM1.5G (100 mW/cm2). This present study can offer design principles and valuable suggestions for eco-friendly solar cells made entirely of thin films, which can achieve flexibility for prospective use in wearable electronics.

Mechanism Underlying Triple VEGFR Inhibitor Tivozanib-Induced Hypertension in Mice Model.

Tivozanib is a triple vascular endothelial growth factor receptor inhibitor, recently approved for the treatment of refractory advanced renal cell carcinoma. Clinical studies showed that around 46% of patients who received tivozanib suffer from hypertension in all grades. Thus, the present study was conducted to identify the role of angiotensin-II (AngII) in the mechanism underlying tivozanib-induced vascular toxicity and hypertension. C57BL/6 male mice received tivozanib (1 mg/kg) with or without losartan (10 or 30 mg/kg) for 3 weeks. Blood pressure was recorded every 3 days, and proteinuria was measured every week. On day 21, all mice were euthanized, and samples were harvested for further analysis. Tivozanib elevated blood pressure until systolic blood pressure reached 163 ± 6.6 mmHg on day 21 of treatment with low urination and high proteinuria. AngII and its receptors, endothelin-1, and oxidative stress markers were significantly increased. While nitric oxide (NO) levels were reduced in plasma and aortic tissues. AngII type 1 receptor blockade by losartan prevented these consequences caused by tivozanib and kept blood pressure within normal range. The results showed that AngII and ET-1 might be potential targets in the clinical studies and management of hypertension induced by tivozanib.

Prevalence and Determinants of Road Traffic Accidents in Saudi Arabia: A Systematic Review.

Globally, the frequency of road traffic accidents (RTAs) is sharply rising. It is concerning that the number of RTAs in the Kingdom of Saudi Arabia (KSA) has risen within the past ten years. As a result, laws governing things like speeding and seat belt use must be implemented to ensure driving safety. This study aims to determine the prevalence and determinants of road traffic accidents in Saudi Arabia. A thorough search was carried out in November 2023, mostly using PubMed, in compliance with PRISMA criteria. The search was limited to English-language research examining the causes of road traffic accidents and their prevalence. Certain inclusion and exclusion criteria were developed to guarantee the quality and applicability of the evaluated research. A wide spectrum of research from Saudi Arabia was included in the study without focusing on a specific gender. A discernible pattern indicated a high proportion of individuals affected by road traffic accidents. According to the findings of our investigation, there is growing evidence that Despite recent improvements in the incidence of road accidents, there is still significant variation in the incidence of accidents in Saudi Arabia. These results indicate that further study is needed to understand road accident prevention better.

A Cross-Sectional Survey Study on the Diagnosis and Management of Critical Illness-Induced Corticosteroid Insufficiency in Saudi Arabia.

Background The presence of critical illness-induced corticosteroid insufficiency (CIRCI) is correlated with elevated concentrations of circulating biomarkers associated with inflammation and coagulation in multiple domains. The management of adrenal insufficiency remains a topic of ongoing debate and disagreement among endocrinologists and intensivists. This study aimed to assess the extent of understanding regarding CIRCI among endocrinologists and intensivists who are actively practicing in Saudi Arabia. Methods This is an online cross-sectional survey study that was conducted between June and August 2023 to assess knowledge of CIRCI among endocrinologists and intensivists working in Saudi Arabia. The questionnaire tool for this study was constructed based on a previous literature review. Binary logistic regression analysis was used to define factors that affect participants' knowledge of CIRCI. Results A total of 76 physicians were involved in this study. Around 32.9% (n= 25) of the participants described CIRCI correctly as an impairment of the hypothalamic-pituitary axis during critical illness. Around 35.5% (n=27) of the participants identified that widespread use of corticosteroids in critically ill patients prompted the need to revisit the concept, diagnosis, and management of CIRCI, and a similar proportion of the participants (35.5%) (n=27) identified that the role of corticosteroids in the management of CIRCI in critically ill patients may be beneficial in selected cases. Around 42.1% (n=32) of the participants identified that CIRCI is specific to critically ill patients while AI can occur in any individual. Around 17.1% (n=13) of the participants confirmed that there is no task force agreement on whether corticosteroids should be used in adult patients with sepsis but without shock. The mean knowledge score of the study participants was 3.6 (sd: 2.2) out of 10, which demonstrates a weak level of knowledge of CIRCI (36.0%). Binary logistic regression analysis identified that physicians from the southern and western regions were less likely to be knowledgeable of CIRCI compared to physicians from the central region (p< 0.05). Conclusion The study revealed that the level of familiarity with CIRCI among endocrinologists and intensivists in Saudi Arabia fell short of the desired benchmark. Clinicians may opt to utilize delta cortisol levels following cosyntropin administration and random plasma cortisol levels as diagnostic measures for CIRCI, instead of relying on plasma-free cortisol or salivary cortisol levels in conjunction with plasma total cortisol. Adherence to customized treatment protocols is crucial to attain the most favorable results for patients.

Foot Care Prioritization Among Health Care Providers Treating Diabetic Patients in Saudi Arabia: A Survey-Based Study.

BACKGROUND: Diabetic foot disease (DFD) is a significant complication associated with diabetes, characterized by the potential for progressive amputation of specific foot segments or the entire lower limb in the absence of timely identification of infection and intervention. The aim of our research is to evaluate the degree of importance given to foot care by healthcare professionals who are responsible for treating individuals with diabetes in Riyadh, Saudi Arabia. METHODS: This cross-sectional study utilized an online survey previously validated in Australia. The mean foot care prioritization score was used to identify the dummy variable for binary logistic regression analysis, which was used to identify predictors of foot care prioritization. RESULTS: A total of 222 participants were involved in this study. Assessing for the risk of developing foot complications, visually inspecting feet for wounds, and providing or recommending footwear to prevent foot complications were the most commonly reported practices, accounting for 80.60% (n = 178), 76.10% (n = 169), and 75.20% (n = 167), respectively. The most commonly referred patients to a specialist tertiary multi-disciplinary foot care team were patients with ulcers in patients with absent foot pulses, ulcers with ascending cellulitis, and diabetic ulceration, accounting for 73.50% (n = 163), 71.60% (n = 159), and 66.70% (n = 148), respectively. The mean foot care prioritization score for the study participants was 54.1 (standard deviation: 11.7) out of 78 (69.4%), which demonstrates a moderately high level of foot care prioritization. Binary logistic regression analysis identified that healthcare professionals who are aged 35-44 years, those who have 5-10 years of experience, those who work at private hospitals, those who have a higher number of practice clinics per week, and those who have to manage a higher number of patients with diabetes in each clinic were more likely to prioritize foot care in their practices (p < 0.05). CONCLUSION: Our study found that healthcare professionals in Saudi Arabia place a moderate degree of emphasis on foot care. Healthcare professionals falling within the age range of 35-44 years, possessing 5-10 years of experience, employed at private hospitals, overseeing a greater number of practice clinics weekly, and managing a greater number of patients with diabetes per clinic exhibited a greater propensity to prioritize foot care within their respective practices. Policymakers should consider the integration of continuous glucose monitoring technologies, the establishment of standardized foot screening protocols, and the implementation of targeted educational programs for healthcare professionals.

Angiotensin II type 1 receptor blockade attenuates gefitinib-induced cardiac hypertrophy via adjusting angiotensin II-mediated oxidative stress and JNK/P38 MAPK pathway in a rat model.

Gefitinib is a tyrosine kinase inhibitor (TKI) of the epidermal growth factor receptor (EGFR), used for the treatment of advanced or metastatic non-small cell lung cancer. Recently, studies proved that Gefitinib-induced cardiotoxicity through induction of oxidative stress leads to cardiac hypertrophy. The current study was conducted to understand the mechanisms underlying gefitinib-induced cardiac hypertrophy through studying the roles of angiotensin II (AngII), oxidative stress, and mitogen-activated protein kinase (MAPK) pathway. Male Wistar albino rats were treated with valsartan, gefitinib, or both for four weeks. Blood samples were collected for AngII and cardiac markers measurement, and hearts were harvested for histological study and biochemical analysis. Gefitinib caused histological changes in the cardiac tissues and increased levels of cardiac hypertrophy markers, AngII and its receptors. Blocking of AngII type 1 receptor (AT1R) via valsartan protected hearts and normalized cardiac markers, AngII levels, and the expression of its receptors during gefitinib treatment. valsartan attenuated gefitinib-induced NADPH oxidase and oxidative stress leading to down-regulation of JNK/p38-MAPK pathway. Collectively, AT1R blockade adjusted AngII-induced NADPH oxidase and JNK/p38-MAPK leading to attenuation of gefitinib-induced cardiac hypertrophy. This study found a pivotal role of AngII/AT1R signaling in gefitinib-induced cardiac hypertrophy, which may provide novel approaches in the management of EGFRIs-induced cardiotoxicity.

Infraocclusion: Prevalence, Characteristics, and Associated Dental Anomalies in Arabian Children.

Aim: To analyze the distribution and characteristics of infraocclusion among Arabian children in primary dentition and its associated dental anomalies. Methods: A radiographic analysis was performed retrospectively using digital panoramic radiographs of children attending the pediatric dental clinic of College of Dentistry, Majmaah University, Saudi Arabia, from January 2019 to May 2021. The panoramic radiographs were analyzed to assess the distribution and characteristics of infraocclusion and its associated dental anomalies. Descriptive statistics were used for comparisons using SPSS version 21.0 (IBM Corp., Armonk, N.Y., USA). The chi-square test was used to compare percentages. Results: Among the study population (542), only 40 children reported infraocclusion of 65 primary molars. Infraocclusion was common in males (90%) and very frequent in the mandibular arch (n = 48 teeth). In the primary dentition, unilateral infraocclusion (62.5%) was very frequent than bilateral presence (37.5%). Single molars were involved in 50% of the patients, while two, three, and four molars were involved in 42.5%, 2.5%, and 5% of cases. The mandibular second primary molar was frequently affected with infraocclusion, while the maxillary first primary molar was less commonly affected. In the mandibular arch, the second primary molar (28, 58%) was more commonly affected with infraocclusion than the mandibular first primary molars and maxillary primary and secondary molars (p < 0.05). The majority of the infraoccluded molars were mild (75%), followed by moderate (23.5%) and severe (1.5%). Hypodontia (12.5%) is frequently associated with infraocclusion, followed by supernumerary teeth (5%) and radix entomolaris of the first permanent mandibular molars (5%). Infraocclusion was more in the second primary molar mandibular arch, while in the maxillary arch, the first primary molars were commonly affected (p > 0.05). Conclusion: In Arabian children, infraocclusion was commonly observed in mandibular second primary molars. Unilateral infraocclusion is a mild type of infraocclusion frequent in Arabian children. Numerical anomalies such as hypodontia and supernumerary teeth are associated with infraocclusion.

Utilization of mouthguards among school children in Saudi Arabia.

AIM: To evaluate attitude towards mouthguard utilization among school children. METHODS: This cross-sectional study was conducted among students of both genders, aged between 8 to 16 years, attending school in Riyadh, Saudi Arabia. A structural questionnaire was prepared consisting of questions related to the demographic details, attitude, and conception of children towards using a mouthguard. The questionnaire was sent to the school teachers to distribute among the respective school children. Descriptive statistics were used to analyze the data. RESULTS: A total of 1116 children completed the survey form, of which 488 were female and 628 male. The prevalence of use of mouthguard among Saudi school children was found to be 3.32%. Out of the total study subjects, 72.68% of the subjects believed that mouthguards could protect them from injuries. The most common reasons for not wearing mouthguards were: they never thought about it (38.47), they felt it was not necessary (30.58%), it was expensive (11.02%), and they never had any injury (19.93%). Out of 37, 2 subjects never experienced any problem with mouthguards. The most common problems with the mouthguards were: difficulty in speech, being uncomfortable and expensive, followed by interference with breathing. CONCLUSION: The prevalence of mouthguard use was 3.32% in Saudi school children aged between 8-16 years. The most common reason for not using it was found to be lack of knowledge. Counseling the young children interested in sports activities is the need of the hour.

Outcomes After Transcatheter Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Diastolic Dysfunction.

OBJECTIVES: Left ventricular diastolic dysfunction (LVDD) in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with poor outcomes; however, the effect of its severity is controversial. We sought to assess the impact of diastolic dysfunction on hospital outcomes and survival after TAVR and identify prognostic factors. METHODS: We included patients who underwent TAVR for severe aortic stenosis with preexisting LVDD from 2009 to 2018 (n = 325). Patients with prior mitral valve surgery (n = 4), atrial fibrillation (n = 39), missing or poor baseline diastolic dysfunction assessment (n = 36) were excluded. The primary endpoint was all-cause mortality. 246 patients were included in the study. RESULTS: The median age was 80 years (25th and 75th percentiles:75-86.7), 154 (62.6%) were males and the median EuroSCORE II was 4.3 (2.2-8). Patients with severe LVDD had significantly higher EuroSCORE, and lower ejection fraction (p < 0.001). There was no difference in post-TAVR new atrial fibrillation (p = 0.912), pacemaker insertion (p = 0.528), stroke (p = 0.76), or hospital mortality (p = 0.95). Patients with severe LVDD had longer hospital stay (p = 0.036). The grade of LVDD did not affect survival (log-rank = 0.145) nor major adverse cardiovascular events (log-rank = 0.97). Predictors of mortality were; low BMI (HR: 0.95 (0.91-0.99); p = 0.019), low sodium (0.93 (0.82-2.5); p = 0.021), previous PCI (HR: 1.6 (1.022-2.66); p = 0.04), E-peak (HR: 1.01 (1.002-1.019); p = 0.014) and implantation of more than one device (HR: 3.55 (1.22-10.31); p = 0.02). CONCLUSION: Transcatheter aortic valve replacement is feasible in patients with diastolic dysfunction, and the degree of diastolic dysfunction did not negatively affect the outcome. Long-term outcomes in those patients were affected by the preoperative clinical state and procedure-related factors.

The awareness of water intake and its correlation with BMI among students attending national and international secondary schools in Riyadh, Saudi Arabia.

Dehydration is linked to worse cognitive functions and preference for beverages that are linked to obesity and other health conditions. Saudi Arabia's hot climate can exacerbate these effects and it is important to ensure that children in the region understand the benefits of adequate water intake. To evaluate secondary school student perceptions and practices regarding water intake, investigate how water intake is related to BMI and school performance, and compare international schools to national schools. This cross-sectional study surveyed understanding and practices relating to water intake of national and international secondary school students using a questionnaire based on a random selection of schools and students. One-hundred and sixty-two students from international schools (I) and 157 from national schools (N) responded. Most were aged 16 and 17 years old (I:61.1%, N:76.5%, p = .005). The average BMI of all students was 24.9 ± 6.013 (I:23.6 ± 4.658, N:26.1 ± 6.931, p < 0.001). Students understood beverages do not replace water intake (I:80.2%, N:75.8%, p = .337) and preferred water when thirsty (I:77.8%, N:75.2%, p = .549). However, water consumption was low with more than 50% of students drinking less than 1500 ml a day (I:54.3%, N:70.7%, p = .002). A positive correlation between BMI and water intake was observed only among international school students. Students have inadequate water intake despite understanding the importance of hydration. There are some differences between international school students and national school students that can be attributed to the availability and sources of water, though other factors cannot be excluded.

Turnover among foreign nurses in Saudi Arabia.

BACKGROUND: Globally, nursing turnover has become a contemporary concern that significantly influences the financial proficiency of healthcare systems. Not only costs, but healthcare accessibility and quality also reverberate the consequence of the phenomenon. DESIGN AND METHODS:   The study explores the factors that attribute to turnover among foreign registered nurses working in Saudi Arabia. A quantitative-based cross-sectional descriptive study design that uses survey data to make statistical inferences about foreign nurse turnover in Saudi Arabia, was conducted to ascertain factors influencing the termination of foreign nurses working with the Ministry of Health (MOH) hospitals. RESULTS: Factors influencing turnover were categorized into 9 dimensions, professional growth and development, leadership style, management, wage and benefits, workload, interpersonal relationship, housing facilities and services, hospital facilities and intent to stay and turn-over intention, of which the professional growth (4.1±0.7) and development had the highest mean agreement scores (4.0±1.1), whereas housing (2.3±1.3) and hospital facilities (2.1±1.0) showed the lowest mean scores.  Conclusions: Wage benefits and workload factors were found to be the most significant causes of expatriate nursing turnover, closely followed by inadequate housing and hospital facilities. Recommendations from nursing staff on how to improve retention were also noted.