Journal articles on the topic 'Triage (Medicine) Saudi Arabia Case studies'

This article provides the conceptual framework for earnings management, which begins by presenting the concept of earnings management, then the actions, motives, techniques, measurement, and then the consequences of this practice. This article also presented studies that dealt with earnings management in the Saudi context. This is because the Kingdom of Saudi Arabia has recently witnessed a clear development in companies and changes in accounting systems which in turn provides an opportunity for more research on earnings management in Saudi Arabia. Several studies provide evidence that EM occurs in Saudi companies, and there are many motivations to practice earnings management in Saudi companies.

Part of the recent Saudi National Transformation program Vision 2030 is the significant growth of the tourism sector. Opening up the country to international tourists means facilitating access to Saudi culture through translation, where the role of translators as cultural mediators is salient. In the Saudi context, cultural mediation in tourism translation is an under-researched topic. This paper addresses the following question: What is interventionst role of translators as cultural mediators and where do they position the tourist against Arabic-English translated Culture-Specific Items (CSIs) in Saudi-related tourism articles? Drawing on Kwieciński’s (2001) adaption of Venuti’s domestication and foreignization (1995), this study adopts a descriptive approach to analyze the translation strategies in a parallel corpus of Arabic and English articles published on the official website of Saudi tourism Visit Saudi. The findings reveal the active role of translators in providing access to the Saudi culture by extensively adopting the exoticization and explanation strategies in tourism texts to foreignize CSIs, especially in the contexts of traditions and food. This paper, thus, bridges the scholarly gap in Translation Studies by examining cultural mediation in translating tourism texts about Saudi Arabia, focusing on translators’ strategies and how they position Saudi CSIs in the international tourism industry.

Flash floods are severe natural disasters due to their suddenness, frequency, and destruction. Every year, flash floods occur in Egypt and Saudi Arabia, which are located in the heart of the Middle East. Extensive areas in Egypt and Saudi Arabia are covered by mountainous topography. Intense rainfall can generate flash floods with their magnitude dependent on geomorphology and storm characteristics. Flash flood hazard assessment is a feasible way to mitigate potential damage and losses. Illumination, review, and comparison of assessment techniques of flash flood hazards represent an urgent necessity to evaluate advances and challenges in this discipline. Google-scholar and Scopus were used to collect 50 recent scientific papers, most of them published between 2011 and 2021, using the keywords: floods, hazards, assessment, Egypt, Saudi Arabia. Remote Sensing (RS) and Geographic Information systems (GIS) are the cornerstones of these studies, which include the Digital Elevation Model (DEM) and geoprocessing tools. The two items facilitate the calculation of morphometric parameters. Dividing the area and determining the hazard level were the main steps in flash flood hazard assessment. The considered studies relied on varied sets of morphometric parameters that ranged from 3 to 24 morphometric parameters. Area, ruggedness ratio, basin shape index, stream frequency, slope index, and drainage density are the common parameters in the assessment of flash flood hazards. In a flood zone, buildings made from brick have better sustainability in terms of both global warming mitigation and life cycle cost than other materials. Future studies are essential to illustrate the relationships between different morphometric parameters and flash flood hazard degree through field data and define a reliable unified set of morphometric parameters to assess the flash flood hazard degree.

It is becoming a topic of increasing significance on a global scale to encourage students in educational institutions of higher learning to behave in an entrepreneurial manner. It is especially true in the countries that make up the Middle East/North Africa (MENA) region, where there is a greater pressing need to cultivate and develop college students into business owners who can financially support themselves through their own businesses. Since only several studies considered the impact of education on aspiring business owners in fast-developing countries like Saudi Arabia, this study helps fill a gap in the existing body of academic research. The primary objective of this research is to evaluate the impact that participation in educational programs about entrepreneurship has on the possibility that college students will be engaged in entrepreneurial activities in the future. It is significant to give education’s central role in cultivating and encouraging entrepreneurship. This investigation utilized the theory of planned behaviour as its primary framework. A convenience sample was used to collect responses to a questionnaire that was administered online. The recruitment process resulted in the participation of a total of 250 individuals who had previously attended institutions in Saudi Arabia and engaged in entrepreneurship education. The findings indicated that an individual’s attitude toward entrepreneurship and their assessment of their level of behavioural control (perceived entrepreneurship abilities) significantly impact an individual’s intention to participate in entrepreneurial activity. On the other hand, subjective norms do not significantly impact the intention to engage in entrepreneurial activity. The most noteworthy finding is that the extent to which students aspire to launch their own businesses is significantly influenced by entrepreneurship education. An explanation of the study’s limitations and some suggestions for more research were presented and discussed further. The study is limited to participation in entrepreneurship education. However, additional research investigating both the quality and quantity of education is also advised.

Guillain-Barré syndrome (GBS) is a heterogeneous disorder with a diverse clinical presentation ranging from weakness of certain body regions to tetraparesis with autonomic dysfunction and respiratory failure. Paraparetic GBS is a variant of GBS which is characterised by weakness limited to the lower limbs only. It is crucial to identify such topographical presentations, as a delay in diagnosis can lead to delayed initiation of specific treatment, which can negatively impact the outcome. We report a 29-year-old female patient who presented to the King Fahd Hospital of the University, Al Khobar, Saudi Arabia, in 2017 with rapid onset asymmetrical weakness of lower extremities associated with bladder dysfunction during the immediate postpartum period. The weakness spared cranial nerves and arms and imaging studies of the spine was unremarkable. Cerebrospinal fluid investigations showed cyto-albuminologic dissociation and nerve conduction studies showed features of demyelination. The patient was diagnosed with a paraparetic variant of GBS and treated with intravenous immunoglobulin. She had almost recovered completely at the two–month follow-up.Keywords: Paraparesis; Guillain-Barré Syndrome; Demyelination; Postpartum Period; Case Report; Saudi Arabia.

Abstract Infrastructure projects are essential for the prosperity of all societies. In many cases, infrastructure assets of different types, both above ground and underground, share the same corridor such as the right of way for roads. Typically, these infrastructure assets are owned and managed by different public and private entities. Failure, delay, or increase in the cost of these projects is clearly reflected with negative impact on society and the economy. Sources of these project deficiencies include poor planning, poor coordination, and weak communication between the concerned entities regarding their ongoing and future plans for their infrastructure assets in a specific corridor. The problem of poor coordination leads to the stumbling of many projects leading to project suspension, cancellation, restudy, and/or redesign. This paper focuses on the pre-planning coordination among the owners of co-located infrastructure assets in Saudi Arabia. Two aspects of the problem are the lack of coordination regarding future projects between parties that has the same interest in a given location and the lack of coordination between those parties regarding existing assets. The objectives of this paper include assessing the current practice in pre-coordination for co-located infrastructure assets and providing recommendations that contribute to improving the coordination among infrastructure owners in their planning process for their infrastructure assets. These objectives are achieved using surveys of owners and contractors of infrastructure projects to validate the identified effects of the poor communication during pre-planning stages and to identify the factors contributing to this problem. In addition, the study involves reviewing case studies in Saudi Arabia, case studies of global success stories, and interviewing experts to identify which lessens are considered fit to Saudi Arabia. The outcome of this research is to provide recommendations/solutions that may contribute to solving the mentioned problems. The importance and the effectiveness of these solutions are discussed to assist decision makers in selecting the best approach to tackle the current issue and maintain the sustainability in the current practices.

Thistudy was designed to estimate the carrier rate of beta-haemolytic streptococci among 972 primary-school boys in a high-altitude area of Saudi Arabia, and its association with social class, crowding index and body mass index, and also to determine the seasonal variation of infection. A carrier rate of 13.1% for beta-haemolytic streptococci was detected. The carrier rate was significantly higher in spring than in winter. The association between streptococcal infection and social class, crowding index, or body mass index was statistically not significant. The low prevalence of streptococcal infection might be attributed to the high altitude but further studies are needed to determine whether this is the case

Learning a new language is a challenging task for many learners. However, it can be an exciting learning process based on several individual difference factors such as self-esteem, anxiety, tolerance of ambiguity, motivation, and attitudes. Thus, this paper focused at examining the attitudes of private college students in Saudi Arabia towards learning the English language for medical academic purposes as it highlights the differences between male and female learners’ attitudes towards learning English language. Relevant data was attained by employing survey questionnaires from a sample of 200 students selected from three private medical colleges that utilize the English language as a medium of instruction in Saudi Arabia. SPSS analysed the accumulated data. The findings dominantly revealed that students have positive attitudes toward learning the English language, especially if the materials are authentic and related to their respective medical areas of concentration and related to their future workplace. Moreover, the study disclosed that there was no significant difference in the learners’ attitudes toward English language learning based on gender. This study’s findings are highly recommended to EFL students, teachers, policymakers, and researchers who are interested in investigating linguistic-associated behaviours. The findings can additionally reinforce related studies or serve as framework for further research studies of the same nature.

Background: On March 2020, the first case of coronavirus disease-19 was registered in the Kingdom of Saudi Arabia and subsequently the first mortality case. The predicting factors for patients' outcomes are essential to triage patients with COVID-19. This may provide low-cost facilities that help in the fight against the existing global pandemic. Objectives: This study aimed to predict hospitalization and death outcomes of COVID-19 patients using the simplest facilities. Method: The electronic medical records of 280 COVID-19 patients between March 2020 and May 2021 were retrieved from a multi-centre of healthcare facilities across Kingdom of Saudi Arabian cites. All demographic and clinical information were examined to determine predictors and outcomes. Results: Of the 280 COVID -19 patients enrolled in our study, 14.3% were aged ≥ 66 years and 62.5% were female. The elderly (≥ 66 years, P= 0.000) and male patients (P= 0.001) were significantly hospitalized by COVID -19 than others. Patients with symptoms were hospitalized significantly more than patients without symptoms (P= 0.001). Patients with chronic conditions were hospitalized more frequently (P= 0.001). Hospitalization status also did not differ by smoking. Fever occurred significantly more frequently in patients with one or more chronic diseases (P = 0.000). Elderly (≥ 66 years, P= 0.000) and male patients of COVID -19 (P= 0.022) had significant evidence of association with death outcome than others. Hospitalization status was associated with death (P = 0.000). Conclusion: This study reported that male gender and advanced age COVID-19 patients are independent predictors for both hospital admission and death outcomes more than others. The COVID-19 patients who complain from symptoms are at risk for hospitalization as well. Additionally, having chronic clinical conditions are predictor factor for hospital admission outcome. Finally, the hospitalized patients of COVID-19 infection are at risk for death outcome.

The outbreak and continuing impact of COVID-19 have significantly increased the rates of hospitalization and admissions to intensive care units (ICU). This study evaluates clinical outcomes in critically ill patients and investigates variables tied to poor prognosis. A secondary database analysis was conducted to investigate the predictors of poor outcome among critically ill COVID-19 patients in Saudi Arabia. Multivariable logistic regression analysis was used to assess the association between various demographic characteristics, comorbidities, and COVID-19 symptoms and patients’ poor prognosis, as a composite outcome. A total of 2257 critically ill patients were identified (male (71.8%), and elderly (37.3%)). The mortality rate was 50.0%, and the composite poor outcome was 68.4%. The predictors of poor outcome were being elderly (OR = 4.79, 95%CI 3.19–7.18), obesity (OR = 1.43, 95%CI 1.1–1.87), having a severe or critical case at admission (OR = 6.46, 95%CI 2.34–17.8; OR = 22.3, 95%CI 11.0–45, respectively), and some signs and symptoms of COVID-19 such as shortness of breath, feeling fatigued or headache, respiratory rate ≥ 30/min, PaO2/FiO2 ratio < 300, and altered consciousness. In conclusion, identifying high-risk populations that are expected to have a poor prognosis based on their criteria upon admission helps policymakers and practitioners better triage patients when faced with limited healthcare resources.

This study was aimed to evaluate the application of software metrics used by the software enterprises present in Saudi Arabia. Extensive literature reviews were conducted to comprehend the current body of knowledge on the use of software metrics in Saudi enterprises. These literature review and studies elapsed approximately two decades. Based on the drawbacks, shortcomings, and fallacies of the existing studies a series of interview questionnaires were developed. Interviews were conducted for collection of real-time and actual data. Around seven Saudi enterprises were selected, and each enterprise was considered and regarded as a unit, and the manager of the enterprise was acting as a unit for our case study. 40 managers were interviewed, and their responses were analyzed. Respondents' responses indicate that the software is useful enough to support business processes. In an attempt to assess the complexity of implementing this software, effective feedback was received, suggesting that there is a lack of communication between the developers and managements’ intent. Moreover, the findings of this study showed that the organization need to give more attention to quality and productivity management. In addition, the results indicate that when agile development is undertaken through software effectiveness, the enterprise's services are implemented appropriately.

Background. We conducted this case-control study to determine the risk factors and treatment outcome of infections due to carbapenem resistant Enterobacteriaceae in our institution.Methods. This is a matched case-control study of patients with infection due to carbapenem resistant Enterobacteriaceae (CRE) and carbapenem susceptible Enterobacteriaceae (CSE), from Riyadh, Saudi Arabia, between March 2012 and December 2013.Results. During this period, 29 cases and 58 controls were studied. The mean ages of the cases (55.4 years) and controls (54.7 years) were similar (p=0.065). Cases had higher mean Charlson comorbidity index (CCI) (3.1) than controls (1.9),p=0.026. Several factors contributed to infection among the studied population. Prior uses of piperacillin-tazobactam, a carbapenem, a quinolone, and metronidazole were significantly associated with CRE infections. Nine of the cases died compared with 7 of the controls,p=0.031. Mortality was associated with advanced age, the presence of comorbidities, ICU stay, and receipt of invasive procedures.Conclusions. Infections due to CRE resulted in a significantly increased mortality. Combination antibiotic therapy was associated with reduced mortality. Properly designed randomized controlled studies are required to better characterize these findings.

Aim. This study is aimed at combining the sample sizes of all studies on permanent maxillary teeth conducted in different regions of the Kingdom of Saudi Arabia (KSA) to obtain a large sample size that represents the population of the KSA. The outcome of these combined studies is compared with international studies in terms of the number of roots, number of canals, and canal configurations on the basis of Vertucci’s classification. Methodology. The studies were systematically reviewed using the Preferred Reporting Items for Systematic Review and Meta-analysis chart. Studies were included in the analysis if they were conducted in the KSA, involved permanent human maxillary teeth, and had a sample of more than 10 teeth (power). By contrast, studies were excluded if they involved deciduous teeth in the sample size, investigated nonhuman teeth, were not conducted in the KSA, and were case reports, case series, review studies, and anomalies. Relevant literature was searched from PubMed, Scopus, Web of Science, Embase, Cochrane, and Direct Science by two calibrated teams, starting in August 2020, without time limits or language restrictions. Results. The database searches and cross-referencing identified a total of 19 relevant studies. All maxillary canines ( N = 1,018 ) had one root, whereas 98.4% had one canal and 98.3% had Vertucci type I. Moreover, 63.2% of the maxillary first premolars had two roots, and 91.4% had two canals. The most common Vertucci root canal configuration was type IV (64.6%). The maxillary second premolars mostly had one root (84.4%) and one canal (50.4%). The most common canal configuration was Vertucci type I (47.1%). The majority of maxillary first molars had three roots (98.9%), 48.7% of which had three canals, and 46.4% had four canals. The most prevalent feature of the canal morphology of mesiobuccal roots was Vertucci type II (35.3%). The investigated maxillary second molars had three roots, 88.0% of which had three canals. Conclusion. This systematic review represents the Saudi population since samples were combined from different studies from different regions of the country. Variations in findings were observed in the same group of teeth from different regions and the same region, while the overall combined samples results fell within the range of other international studies.

Objective There have been few studies on hematological parameters (e.g., hemoglobin, red cell distribution width, white blood cells, and mean platelet volume), and polycystic ovary syndrome (PCOS). This study aimed to compare hematological parameters between women with PCOS and controls. Methods We performed an age-matched case–control study in Faisal bin Mishal Center for Infertility, Buraidah (Kingdom of Saudi Arabia). The cases were women with PCOS and an equal number of healthy women were enrolled as controls. The basic gynecological history was recorded and blood samples were analyzed for blood parameters using an automated hematology analyzer. Results The two groups (60 women in each arm of the study) were similar in age. However, body mass index was significantly higher in women with PCOs compared with controls. There were no significant differences in any of the hematological parameters (hemoglobin, red blood cells, red cell distribution width, white blood cells, platelets, and mean platelet volume) between the two groups. Conclusion There does not appear to be a significant difference in hematological parameters in Saudi women with PCOS and healthy controls. A larger study on this issue is required in the future.

This article studies one of the humanitarian challenges caused by the COVID-19 crisis: the dignified handling of the mortal remains of individuals that have died from COVID-19 in Muslim contexts. It illustrates the discussion with examples from Sunni Muslim-majority states when relevant, such as Egypt, the Kingdom of Saudi Arabia, Jordan, Morocco and Pakistan, and examples from English-speaking non-Muslim majority states such as the United Kingdom, the United States of America, Canada and Australia as well as Sri Lanka. The article finds that the case of the management of dead bodies of people who have died from COVID-19 has shown that the creativity and flexibility enshrined in the Islamic law-making logic and methodology, on the one hand, and the cooperation between Muslim jurists and specialised medical and forensic experts, on the other, have contributed to saving people’s lives and mitigating the effects of the COVID-19 pandemic in Muslim contexts.

Background: Evidently, Complementary and Alternative Medicine (CAM) is increasingly a recognized medical practice that efficiently uses multiple treatment therapies and techniques in promoting the health and wellbeing of people as well as preventing and managing a variety of human disorders. Research in CAM, which courses exposure to diverse healthcare professionals, is important from many perspectives including improvement in teaching skills of faculty, enhancing capacity building, and innovative curriculum development. This pre- and post-design crosssectional study aimed to assess perceptions, training needs, personal usage, use in office practice, and knowledge of two batches of medical students toward CAM therapies in Majmaah University, Saudi Arabia. Materials and Methods: The second year medical students of the first (year 2012-13) and second (year 2013-2014) batch [n=26 & 39, respectively] were selected for this study. A reliable 16-item self-administered questionnaire was distributed among all students for answering before and after the 48-hour specific 19 CAM therapies course, in terms of CAM therapies are clearly conventional or alternative, training needs, effectiveness, personal use, use in practice, management of two clinical cases by CAM or conventional therapies, and views about which evidence based approach strongly support individual CAM modalities. Results: Medical students' knowledge and perceptions of CAM therapies significantly improved across some sub-items of CAM questionnaire with a positive trend in the rest of its items including their views about CAM therapies, need for further training, personal use of therapies and advising patients regarding CAM practices strongly supported by randomized clinical controlled trials and published case studies. Conclusion: CAM course tends to have positive impact on the knowledge and perceptions of medical students, in addition to need for further training, and personal use and use of CAM therapies in practice in line with strong evidence-based data regarding therapeutic efficacy. The preliminary results of this study call for further research in specific CAM modalities with a larger sample in academic settings across the nation.

Background.The paranasal sinuses in pediatrics can harbor a wide variety of pathologies. With the present literature being composed of case studies only, this entity is quite understudied. Objectives. This article aims to study the clinical presentation, diagnosis, and endoscopic management of six different rare frontal sinus pathologies in pediatrics, which include extensive allergic fungal sinusitis, mucoceles, osteoma, superior sagittal sinus thrombosis, CSF leak, and subdural empyema. Methods. We retrospectively studied all pediatric patients with frontal sinus pathologies presenting to our center, King Fahad Specialist Hospital, Dammam, Saudi Arabia, from the period of 2006 to 2020. Results. A total of 8 patients presented to our hospital with different frontal sinus pathologies. 5 of them were males, and 3 were females with an age of presentation ranging from 7 to 17 years. The diagnosis and localization were performed through computerized tomography without contrast and magnetic resonance imaging, when indicated. All cases were primarily managed with endonasal endoscopic approaches successfully without complications and with no recurrence evident upon follow-up. Conclusion. In this case series, six different frontal sinus pathologies were managed by an endoscopic approach, with excellent recovery and no recurrence upon follow-up demonstrated. This approach enabled excellent visualization of the pathologies, accurate localization, adequate drainage, and repair or grafting when needed.

A significant gap exists between availability of organs for transplant and patients with end-stage organ failure for whom organ transplantation is the last treatment option. Reasons for this mismatch include inadequate approach to potential donor families and donor loss as a result of refractory cardiopulmonary instability during and after brainstem herniation. Other reasons include inadequate cultural competence and sensitivity when communicating with potential donor families. Clinicians may not have an understanding of the cultural and religious perspectives of Muslim families of critically ill patients who may be approached about brain death and organ donation. This review analyzes Islamic cultural and religious perspectives on organ donation, transplantation, and brain death, including faith-based directives from Islamic religious authorities, definitions of death in Islam, and communication strategies when discussing brain death and organ donation with Muslim families. Optimal family care and communication are highlighted using case studies and backgrounds illustrating barriers and approaches with Muslim families in the United States and in the Kingdom of Saudi Arabia that can improve cultural competence and family care as well as increase organ availability within the Muslim population and beyond.

Behcet syndrome (BS) is a multisystemic perivasculitis whose genetic susceptibility is linked to HLA region. We first meta-analysed all HLA class I and II genes involved in BS susceptibility in all ethnic groups worldwide. We identified 1141 articles and finally included 31 case-control studies after multiple rounds of selection. We analysed frequencies for 24 HLA-A alleles (3 alleles for HLA-A ∗ 26 at four digits), 50 HLA-B alleles (11 alleles for HLA-B ∗ 51 at four digits), 15 HLA-C alleles, 16 HLA-DRB1 alleles, 6 HLA-DQB1 alleles, and 15 HLA-DPB1 alleles. We meta-analysed only HLA allelic frequencies from at least three studies; therefore, we investigated 21 alleles out of 140. Going from 7.00 to 1.6 OR, we found 11 class I alleles conferring risk for BS: B ∗ 51 : 08 , B ∗ 51 , B ∗ 51 : 01 , B ∗ 51 : 02 , DQB 1 ∗ 03 , A ∗ 26 : 01 , Cw ∗ 14 , Cw ∗ 15 , Cw ∗ 16 , B ∗ 15 , and A ∗ 26 . Overall, the studies included populations from Europe (Greece, Spain, Italy, Germany, and Ireland), Asia (Korea, China, China Han, and Thailand), Middle East (Israel, Saudi Arabia, and Iran), and Morocco (as no other North-African population was included). We collected a number of ethnical groups sufficient to conduct an ethnic-specific meta-analysis where Europeans showed 11.25 OR for B ∗ 51:08 and Japan 3.50 OR for A ∗ 26 : 01 . A remarkable result was that the most frequent HLA − B ∗ 51 two-digit alleles associated with BS were different among populations: HLA − B ∗ 51 : 08 in Europe, HLA − B ∗ 51 : 01 in Turkey, and HLA − B ∗ 51 : 02 in Japan. Overall, we discussed our real-world results with other imputation studies.

Aims: To report the outcomes and complications of deep sclerectomy in glaucoma secondary to Sturge–Weber syndrome (SWS). Methods: The retrospective case series included patients with SWS and secondary glaucoma who underwent deep sclerectomy at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia between 2000 and 2021. The main outcome measures included intraocular pressure (IOP), the number of antiglaucoma medications, the presence of vision-threatening complications, and the need for further glaucoma surgery to control the IOP. The surgical outcome of each eye was based on the main outcome measures. Results: Twelve eyes of eleven patients were included in the study. The mean follow-up period was 83.00 months (±74.2) (range 1 to 251 months). The IOP and number of antiglaucoma medications decreased significantly from a mean of 28.75 mm Hg (±7.4) and 3.17 (±0.8) to 15.30 mm Hg (±3.5) and 0.3 (±0.7), and 18.83 (±9.3) and 1.67 (±1.7) on the 24th month and the last follow-up visit postoperatively, respectively (p < 0.01 for both). The success rate was 66.6% (8/12), while the failure rate was 33.3% (4/12) because of the uncontrolled IOP where a single repeat glaucoma surgery achieved controlled IOP. One procedure was complicated by choroidal detachment and one by choroidal effusion; both complications were resolved by medical treatments. Conclusions: Deep sclerectomy seems to be an effective treatment modality for controlling IOP and for decreasing the burden of antiglaucoma medications in patients with SWS and secondary glaucoma. Further studies are needed to confirm such a conclusion on larger number of patients with longer follow-up periods.

Background: Sedentary lifestyles, urbanization and improvements in socio-economic status have had serious effects on the burden of diabetes across the world. Diabetes is one of the 10 leading causes of death globally, and individuals with diabetes have a 2–3-fold increased risk of all-cause mortality. Adipose tissue is increasingly understood as a highly active endocrine gland that secretes many biologically active substances, including adipocytokines. However, the exact and discrete pathophysiological links between obesity and T2DM are not yet fully elucidated. Methods: In the current study, we present the association of five diverse adipocytokines, adiponectin, leptin, resistin, visfatin and chemerin, with T2DM in 87 patients (46 males and 41 females) with type 2 diabetes mellitus and 85 healthy controls (44 males and 41 females) from the Asir region of Saudi Arabia. The patients were divided into four groups: normal BMI, overweight, obese and severely obese. The baseline biochemical characteristics, including HbA1c and anthropometric lipid indices, such as BMI and waist–hip ratio, were determined by standard procedures, whereas the selected adipokine levels were assayed by ELISA. Results: The results showed significantly decreased levels of adiponectin in the T2DM patients compared to the control group, and the decrease was more pronounced in obese and severely obese T2DM patients. Serum leptin levels were significantly higher in the females compared to the males in the controls as well as all the four groups of T2DM patients. In the male T2DM patients, a progressive increase was observed in the leptin levels as the BMI increased, although these only reached significantly altered levels in the obese and severely obese patients. The serum leptin levels were significantly higher in the severely obese female patients compared to the controls, patients with normal BMI, and overweight patients. The leptin/adiponectin ratio was significantly higher in the obese and severely obese patients compared to the controls, patients with normal BMI, and overweight patients in both genders. The serum resistin levels did not show any significant differences between the males and females in thr controls or in the T2DM groups, irrespective of the BMI status of the T2DM patients. The visfatin levels did not reveal any significant gender-based differences, but significantly higher levels of visfatin were observed in the T2DM patients, irrespective of their level of obesity, although the higher values were observed in the obese and highly obese patients. Similarly, the serum chemerin levels in the controls, as well as in T2DM patients, did not show any significant gender-based differences. However, in the T2DM patients, the chemerin levels showed a progressive increase, with the increase in BMI reaching highly significant levels in the obese and severely obese patients, respectively. Conclusion: In summary, it is concluded that significantly altered concentrations of four adipokines, adiponectin, leptin, visfatin and chemerin, were found in the T2DM patient group compared to the controls, with more pronounced alterations observed in the obese and highly obese patients. Thus, it can be surmised that these four adipokines play a profound role in the onset, progression and associated complications of T2DM. In view of the relatively small sample size in our study, future prospective studies are needed on a large sample size to explore the in-depth relationship between adipokines and T2DM.

In this decade, the entire world realized that a healthy environment is needed for mitigating catastrophic issues created by the nature. Thus, the green bond was introduced in 2007, and the green Sukuk was issued in 2017. Malaysia took the pioneering role for issuing green Sukuk and issued ten green Sukuk within 2020. Furthermore, Indonesia has taken initiative for issuing five green Sukuk in 2018. Besides that, Saudi Arabia issued two green Sukuk and the United Arab Emirates also issued two green Sukuk in 2019. As the green Sukuk was issued in various sectors which created a curiosity to know, what are the policies were created, how did they apply and how do they impact on the environment. Accordingly, the study aims to find out implemented policies to mitigate challenges for issuing all green Sukuk in four nations. So, this study was conducted through case studies on green Sukuk by analysing available data from the green Sukuk issuers, ministries, published literature and others. The study found that green Sukuk issuers were implemented the same policies that applied to issue green bonds and still remain a great challenge. It is because, every nation has a different geographical atmosphere, culture, religion and human behaviours. In addition, the study also found that all of the green Sukuk-issued projects were selected to reduce air pollution. Therefore, further research is needed on policy and project creation according to the nation for controlling other factors, such as; pollution (water, land, and sound), deforestation, and others.

The global spread of Salafism, though it began in the 1960s and 1970s, only started to attract significant attention from scholars and analysts outside of Islamic studies as well as journalists, politicians, and the general public following the September 11, 2001 terrorist attacks perpetrated by Al-Qaeda Central. After the attacks, Salafism—or, as it was pejoratively labeled by its critics inside and outside of the Islamic tradition, “Wahhabism”—was accused of being the ideological basis of all expressions of Sunni militancy from North America and Europe to West and East Africa, the Arab world, and into Asia. According to this narrative, Usama bin Laden, Ayman al-Za- wahiri, Abu Bakr al-Baghdadi, and other Sunni jihadis were merely putting into action the commands of medieval ‘ulama such as Ibn Taymiyya, the eighteenth century Najdi Hanbali Muhammad ibn ‘Abd al-Wahhab, and modern revolutionary ideologues like Sayyid Qutb and ‘Abdullah ‘Azzam. To eradicate terrorism, you must eliminate or neuter Salafism, say its critics. The reality, of course, is far more complex than this simplistic nar- rative purports. Salafism, though its adherents share the same core set of creedal beliefs and methodological approaches toward the interpretation of the Qur’an and hadith and Sunni legal canon, comes in many forms, from the scholastic and hierarchical Salafism of the ‘ulama in Saudi Arabia and other Muslim majority countries to the decentralized, self-described Salafi groups in Europe and North America who cluster around a single char- ismatic preacher who often has limited formal religious education. What unifies these different expressions of Salafism is a core canon of religious and legal texts and set of scholars who are widely respected and referenced in Salafi circles. Thurston grounds his fieldwork and text-based analysis of Salafism in Nigeria, Africa’s most populous country and home to one of the world’s largest single Muslim national populations, through the lens of this canon, which he defines as a “communally negotiated set of texts that is governed by rules of interpretation and appropriation” (1). He argues fur- ther that in the history of Nigerian Salafism, one can trace the major stages that the global Salafi movement has navigated as it spread from the Arab Middle East to what are erroneously often seen as “peripheral” areas of the Islamic world, Africa and parts of Asia. The book is based on extensive fieldwork in Nigeria including interviews with key Nigerian Salafi scholars and other leading figures as well as a wide range of textual primary sourc- es including British and Nigerian archival documents, international and national news media reports, leaked US embassy cables, and a significant number of religious lectures and sermons and writings by Nigerian Salafis in Arabic and Hausa. In Chapter One, Thurston argues that the Salafi canon gives individ- ual and groups of Salafis a sense of identity and membership in a unique and, to them, superior religious community that is linked closely to their understanding and reading of sacred history and the revered figures of the Prophet Muhammad and the Ṣaḥāba. Salafism as an intellectual current, theology, and methodological approach is transmitted through this can- on which serves not only as a vehicle for proselytization but also a rule- book through which the boundaries of what is and is not “Salafism” are determined by its adherents and leading authorities. The book’s analytical framework and approach toward understanding Salafism, which rests on seeing it as a textual tradition, runs counter to the popular but problematic tendency in much of the existing discussion and even scholarly literature on Salafism that defines it as a literalist, one-dimensional, and puritani- cal creed with a singular focus on the Qur’an and hadith canon. Salafis, Thurston argues, do not simply derive religious and legal rulings in linear fashion from the Qur’an and Prophetic Sunna but rather engage in a co- herent and uniform process of aligning today’s Salafi community with a set of normative practices and beliefs laid out by key Salafi scholars from the recent past. Thurston divides the emergence of a distinct “Salafi” current within Sunnis into two phases. The first stretches from 1880 to 1950, as Sun- ni scholars from around the Muslim-majority world whose approaches shared a common hadith-centered methodology came into closer contact. The second is from the 1960s through the present, as key Salafi institutions (such as the Islamic University of Medina and other Saudi Salafi bodies) were founded and began attracting and (perhaps most importantly) fund- ing and sponsoring Sunni students from countries such as Nigeria to come study in Saudi Arabia, where they were deeply embedded in the Salafi tra- dition before returning to their home countries where, in turn, they spread Salafism among local Muslims. Nigeria’s Muslim-majority north, as with other regions such as Yemen’s northern Sa‘ada governorate, proved to be a fertile ground for Salafism in large part because it enabled local Muslims from more humble social backgrounds to challenge the longtime domi- nance of hereditary ruling families and the established religious class. In northern Nigeria the latter was and continues to be dominated by Sufi or- ders and their shaykhs whose long-running claim to communal leadership faced new and substantive theological and resource challenges following the return of Nigerian seminary students from Saudi Arabia’s Salafi scho- lastic institutions in the 1990s and early 2000s. In Chapters Two and Three, Thurston traces the history of Nigerian and other African students in Saudi Arabia, which significantly expanded following the 1961 founding of the Islamic University of Medina (which remains the preeminent Salafi seminary and university in the world) and after active outreach across the Sunni Muslim world by the Saudi govern- ment and Salafi religious elite to attract students through lucrative funding and scholarship packages. The process of developing an African Salafism was not one-dimensional or imposed from the top-down by Saudi Salafi elites, but instead saw Nigerian and other African Salafi students partici- pate actively in shaping and theorizing Salafi da‘wa that took into account the specifics of each African country and Islamic religious and social envi- ronment. In Nigeria and other parts of West and East Africa, this included considering the historically dominant position of Sufi orders and popular practices such as devotion to saints and grave and shrine visitation. African and Saudi Salafis also forged relationships with local African partners, in- cluding powerful political figures such as Ahmadu Bello and his religious adviser Abubakar Gumi, by attracting them with the benefits of establishing ties with wealthy international Islamic organizations founded and backed by the Saudi state, including the Muslim World League. Nigerian Salafis returning from their studies in Saudi Arabia actively promoted their Salafi canon among local Muslims, waging an aggressive proselytization campaign that sought to chip away at the dominance of traditional political and religious elites, the Sufi shaykhs. This process is covered in Chapter Four. Drawing on key sets of legal and exegetical writ- ings by Ibn Taymiyya, Muhammad ibn ‘Abd al-Wahhab, and other Salafi scholars, Nigerian Salafis sought to introduce a framework—represented by the canon—through which their students and adherents approach re- ligious interpretation and practice. By mastering one’s understanding and ability to correctly interpret scripture and the hadith, Salafis believe, one will also live a more ethical life based on a core set of “Salafi” principles that govern not only religious but also political, social, and economic life. Salaf- ism, Thurston argues, drawing on the work of Terje Østebø on Ethiopian Salafism, becomes localized within a specific environment.As part of their da‘wa campaigns, Nigerian Salafis have utilized media and new technology to debate their rivals and critics as well as to broad- en their own influence over Nigerian Muslims and national society more broadly, actions analyzed in Chapter Five. Using the Internet, video and audio recorded sermons and religious lectures, books and pamphlets, and oral proselytization and preaching, Nigerian Salafis, like other Muslim ac- tivists and groups, see in media and technology an extension of the phys- ical infrastructure provided by institutions such as mosques and religious schools. This media/cyber infrastructure is as, if not increasingly more, valuable as the control of physical space because it allows for the rapid spread of ideas beyond what would have historically been possible for local religious preachers and missionaries. Instead of preaching political revo- lution, Nigerian Salafi activists sought to win greater access to the media including radio airtime because they believed this would ultimately lead to the triumph of their religious message despite the power of skeptical to downright hostile local audiences among the Sufi orders and non-Salafis dedicated to the Maliki juridical canon.In the realm of politics, the subject of Chapter Six, Nigeria’s Salafis base their political ideology on the core tenets of the Salafi creed and canon, tenets which cast Salafism as being not only the purest but the only true version of Islam, and require of Salafis to establish moral reform of a way- ward Muslim society. Salafi scholars seek to bring about social, political, and religious reform, which collectively represent a “return” to the Prophet Muhammad’s Islam, by speaking truth to power and advising and repri- manding, as necessary, Muslim political rulers. In navigating the multi-po- lar and complex realm of national and regional politics, Thurston argues, Nigerian Salafi scholars educated in Saudi Arabia unwittingly opened the door to cruder and more extreme, militant voices of figures lacking the same level of study of the Salafi canon or Sunni Islam generally. The most infamous of the latter is “Boko Haram,” the jihadi-insurgent group today based around Lake Chad in Nigeria, Chad, and Niger, which calls itself Jama‘at Ahl al-Sunna li-l-Da‘wa wa-l-Jihad and is led by the bombastic Abubakar Shekau. Boko Haram, under the leadership first of the revivalist preacher Mu- hammad Yusuf and then Shekau, is covered at length in the book’s third and final part, which is composed of two chapters. Yusuf, unlike mainstream Nigerian Salafis, sought to weaponize the Salafi canon against the state in- stead of using it as a tool to bring about desired reforms. Drawing on the writings of influential Arab jihadi ideologues including Abu Muhammad al-Maqdisi and the apocalyptic revolutionary Juhayman al-‘Utaybi, the lat- ter of whom participated in the 1979 seizure of the Grand Mosque in Mecca, Yusuf cited key Salafi concepts such as al-walā’ min al-mu’minīn wa-l-bara’ ‘an al-kāfirīn (loyalty to the Believers and disavowal of the Disbelievers) and beliefs about absolute monotheism (tawḥīd) as the basis of his revival- ist preaching. Based on these principle, he claimed, Muslims must not only fulfill their ritual duties such as prayer and fasting during Ramadan but also actively fight “unbelief” (kufr) and “apostasy” (ridda) and bring about God’s rule on earth, following the correct path of the community of the Prophet Abraham (Millat Ibrāhīm) referenced in multiple Qur’anic verses and outlined as a theological project for action by al-Maqdisi in a lengthy book of that name that has had a profound influence on the formation of modern Sunni jihadism. Instead of seeing Boko Haram, particularly under Shekau’s leadership, as a “Salafi” or “jihadi-Salafi” group, Thurston argues it is a case study of how a group that at one point in its history adhered to Salafism can move away from and beyond it. In the case of Shekau and his “post-Salafism,” he writes, the group, like Islamic State, has shifted away from the Salafi canon and toward a jihadism that uses only stripped-down elements from the canon and does so solely to propagate a militaristic form of jihad. Even when referencing historical religious authorities such as Ibn Taymiyya, Thurston points out, Boko Haram and Islamic State leaders and members often do so through the lens of modern Sunni jihadi ideologues like Juhay- man al-‘Utaybi, al-Maqdisi, and Abu Mus‘ab al-Zarqawi, figures who have come to form a Sunni jihadi canon of texts, intellectuals, and ideologues. Shekau, in short, has given up canonical Salafism and moved toward a more bombastic and scholastically more heterodox and less-Salafi-than- jihadi creed of political violence. Thurston also pushes back against the often crude stereotyping of Af- rican Islamic traditions and movements that sees African Muslims as being defined by their “syncretic” mix of traditional African religious traditions and “orthodox” Islam, the latter usually a stand-in for “Arab” and “Middle Eastern” Islam. Islam and Islamic movements in Africa have developed in social and political environments that are not mirrors to the dominant models of the Arab world (in particular, Egypt). He convincingly points out that analysis of all forms of African Islamic social and political mobi- lization through a Middle East and Egypt-heavy lens obscures much more than it elucidates. The book includes useful glossaries of key individuals and Arabic terms referenced in the text as well as a translation of a sermon by the late, revered Salafi scholar Muhammad Nasir al-Din al-Albani that is part of the mainstream Salafi canon. Extensive in its coverage of the his- tory, evolution, and sociopolitical and religious development of Salafism in Nigeria as well as the key role played by Saudi Salafi universities and religious institutions and quasi-state NGOs, the book expands the schol- arly literature on Salafism, Islam in Africa, and political Islam and Islamic social movements. It also contributing to ongoing debates and discussions on approaches to the study of the role of texts and textual traditions in the formation of individual and communal religious identity. Christopher AnzaloneResearch Fellow, International Security ProgramBelfer Center for Science and International Affairs, Harvard University& PhD candidate, Institute of Islamic Studies, McGill University

More than 60% of human viral pathogens are of zoonotic origin, resulting from accidental or frequent animal infections. Bats are reservoirs of various viruses, pathogens in humans of varying severity from mild asymptomatic forms to severe lethal outcomes. And are associated with the spread of various viruses (Marburg virus, Ebola virus) and, above all, coronaviruses. Since the 2000s, three independent outbreaks of coronaviruses with the emergence of new zooanthroponotic human coronaviruses (Betacoronavirus) with epidemic and pandemic potential have been registered. The first outbreak was reported in 2002 (SARS), caused by SARS-CoV, in the PRC (Guangdong Province). The second outbreak occurred in 2012 (MERS, MERS), associated with MERS-CoV, Saudi Arabia. The third occurred in 2019 PRC (Hubei Province), this case evolved into a COVID-19 pandemic caused by SARS-CoV-2. These cases seem to be independent, but the literature reports that the emergence of all these viruses is related to evolutionary processes driven by environmental and genetic aspects. It is assumed that the coronavirus causative agent of severe acute respiratory syndrome-2 (SARS-CoV-2) originated from a coronavirus-infected bat of the genus Rhinolophus. After initial emergence, due to the host vector. SARS-CoV-2 is now transmitted worldwide through human-to-human transmission. Data from experimental studies show that animal species such as cats, ferrets, raccoon dogs, Javanese macaques, rhesus macaques, white-tailed deer, rabbits, Egyptian fruit bats and Syrian hamsters are susceptible to SARS-CoV-2 infection. However, natural SARS-CoV-2 infections have only been reported in domestic dogs and cats, tigers, lions, snow leopards, cougars and gorillas in zoos, and farm-raised mink and ferrets. Although human-to-animal transmission has been reported in several cases, animal-to-human transmission of SARS-CoV-2 has been reported only from mink to humans on mink farms.

On 27-28 March 2006, Pennsylvania State University hosted an internationalconference on “Islam and Bioethics: Concerns, Challenges, and Responses.”Cosponsored by several academic units in the College of Liberal Arts, theconference brought in historians, health care professionals, theologians, and social scientists from ten different countries. Twenty-four papers were presented,along with Maren Grainger-Monsen’s documentary about an Afghaniimmigrant seeking cancer treatment in California.After opening remarks by Susan Welch (dean, College of Liberal Arts)and Nancy Tuana (director, Rock Ethics Institute), panelists analyzed“Critical Perspectives on Islamic Medical Ethics.” Hamada Hamid’s (NewYork University Medical School) “Negotiating Autonomy and Religion inthe Clinical Setting: Case Studies of American Muslim Doctors andPatients,” showed that few doctors explore the role of religion in a patient’sdecision-making process. She suggested that they rethink this practice.Hassan Bella (College of Medicine, King Faisal University, Dammam)spoke on “Islamic Medical Ethics: What and How to Teach.” His survey, conductedin Saudi Arabia among medical practitioners, revealed that most practitionersapproved of courses on Islamic ethics but did not know if suchcourses would improve the doctor-patient relationship. Sherine Hamdy’s(Brown University) “Bodies That Belong to God: Organ Transplants andMuslim Ethics in Egypt” maintained that one cannot easily classify transplantpatients’ arguments as “religious” or “secular,” for religious values are fusedtogether with a patient’s social, political, and/or economic concerns.The second panel, “Ethical Decision-Making in Local and InternationalContexts,” provoked a great deal of discussion. Susi Krehbiel (Brown University)led off with “‘Women Do What They Want’: Islam and FamilyPlanning in Tanzania.” This ethnographic study was followed by Abul FadlMohsin Ebrahim’s (KwaZulu University, Durban) “Human Rights andRights of the Unborn.” Although Islamic law is commonly perceived asantagonistic to the UN’s charter on human rights, Ebrahim argues that bothmay be used to protect those who can and cannot fight for their right to dignity,including the foetus. Thomas Eich (Bochum University) asserted in“The Process of Decision Making among Contemporary Muslim ReligiousScholars in the Case of ‘Surplus’ Embryos” that decisions reached by internationalMuslim councils were heavily influenced by local politics and contentiousdecisions in such countries as Germany and Australia.The afternoon panel, “The Fetus and the Value of Fetal Life,” focusedon specific issues raised by artificial reproductive technologies (ARTs).Vardit Rispler-Chaim (Haifa University) presented “Contemporary Muftisbetween Bioethics and Social Reality: Pre-Selection of the Sex of a Fetus asParadigm.” After summarizing social customs and religious literature fromaround the world, she claimed that muftis generally favor pre-selection techniquesand suggested that their reasoning is guided by a general social ...

The DebateQuestion 1: Various commentators have frequently invoked the importance of moderate Muslims and the role that they can play in fighting extremism in the Muslim world. But it is not clear who is a moderate Muslim. The recent cancellation of Tariq Ramadan’s visa to the United States, the raids on several American Muslim organizations, and the near marginalization of mainstream American Muslims in North America pose the following question: If moderate Muslims are critical to an American victory in the war on terror, then why does the American government frequently take steps that undermine moderate Muslims? Perhaps there is a lack of clarity about who the moderate Muslims are. In your view, who are these moderate Muslims and what are their beliefs and politics? AC: I would like to say from the outset that I am neither a Muslim nor a sociologist. Therefore, my remarks should be taken as those of an interested and sympathetic outsider. I do not believe at all that the American government “undermines” moderate Muslims. The problem is more complicated. Many American officials abhor engagement in religion or the politics of religion. They believe that the American Constitution separates religion and state and does not allow them to make distinctions when it comes to different interpretations of Islam. For some of them, Salafiya Islam is as good as Sufi Islam. Others do not have a sufficient knowledge base to sort out the moderates from the radicals, identify the retrograde fundamentalists, or recognize modernizers who want political Islam to dominate. This is wrong. Radical ideologies have to do more with politics and warfare than religion, and, in some extreme cases, should not enjoy the constitutional protections of freedom of religion or free speech. There is a difference between propagating a faith and disseminating hatred, violence, or murder. The latter is an abuse and exploitation of faith for political ends, and should be treated as such. For example, the racist Aryan Nation churches were prosecuted and bankrupted by American NGOs and the American government. One of the problems is that the American government allows radical Muslims who support terrorism to operate with impunity in the United States and around the world, and does very little to support moderate Muslims, especially in the conflict zones. To me, moderate Muslims are those who do not view the “greater jihad” either as a pillar of faith or as a predominant dimension thereof. A moderate is one who is searching for a dialogue and a compromise with people who adhere to other interpretations of the Qur’an, and with those who are not Muslim. Amoderate Sunni, for example, will not support terror attacks on Shi`ahs or Sufis, or on Christians, Jews, or Hindus. Moderate Muslims respect the right of individuals to disagree, to worship Allah the way they chose, or not to worship – and even not to believe. Amoderate Muslim is one who is willing to bring his or her brother or sister to faith by love and logic, not by mortal threats or force of arms. Amoderate Muslim decries suicide bombings and terrorist “operations,” and abhors those clerics who indoctrinate toward, bless, and support such atrocities. The list of moderate Muslims is too long to give all or even a part of it here. Shaykh Muhammad Hisham Kabbani (chairman of the Islamic Supreme Council of America) and Sheikh Abdul Hadi Palazzi (secretarygeneral of the Rome-based Italian Muslim Association) come to mind. Ayatollah Ali Sistani may be a moderate, but I need to read more of his teachings. As the Wahhabi attacks against the Shi`ah escalate, Shi`i clerics and leaders are beginning to speak up. Examples include Sheikh Agha Jafri, a Westchester-based Pakistani Shi`ah who heads an organization called the Society for Humanity and Islam in America, and Tashbih Sayyed, a California-based Pakistani who serves as president of the Council for Democracy and Tolerance. I admire the bravery of Amina Wadud, a female professor of Islamic studies at Virginia Commonwealth University who led a mixed-gender Friday Islamic prayer service, according to Mona Eltahawy’s op-ed piece in The Washington Post on Friday, March 18, 2005 (“A Prayer Toward Equality”). Another brave woman is the co-founder of the Progressive Muslim Union of America, Sarah Eltantawi. And the whole world is proud of the achievements of Judge Shirin Ebadi, the Iranian human rights lawyer who was awarded the Nobel peace prize in 2003. There is a problem with the first question, however. It contains several assumptions that are debatable, to say the least, if not outright false. First, it assumes that Tariq Ramadan is a “moderate.” Nevertheless, there is a near-consensus that Ramadan, while calling for ijtihad, is a supporter of the Egyptian Ikhwan al-Muslimin [the Muslim Brotherhood] and comes from that tradition [he is the grandson of its founder, Hasan al-Banna]. He also expressed support for Yusuf al-Qaradawi (and all he stands for) on a BBC TVprogram, and is viewed as an anti-Semite. He also rationalizes the murder of children, though apparently that does not preclude the European Social Forum from inviting him to be a member. He and Hasan al-Turabi, the founder of the Islamic state in Sudan, have exchanged compliments. There are numerous reports in the media, quoting intelligence sources and ex-terrorists, that Ramadan associates with the most radical circles, including terrorists. In its decision to ban Ramadan, the United States Department of Homeland Security was guided by a number of issues, some of them reported in the media and others classified. This is sufficient for me to believe that Ramadan may be a security risk who, in the post-9/11 environment, could reasonably be banned from entering the United States.1 Second, the raids on “American Muslim organizations” are, in fact, a part of law enforcement operations. Some of these steps have had to do with investigations of terrorist activities, such as the alleged Libyan conspiracy to assassinate Crown Prince Abdullah of Saudi Arabia. Others focused on American Islamist organizations that were funding the terrorist activities of groups on the State Department’s terrorism watch list, such as Hamas. To say that these criminal investigations are targeting moderate Islam is like saying that investigating pedophile priests undermines freedom of religion in the United States. Finally, American Muslims are hardly marginalized. They enjoy unencumbered religious life and support numerous non-governmental organizations that often take positions highly critical of domestic and foreign policy – something that is often not the case in their countries of origin. There is no job discrimination – some senior Bush Administration officials, such as Elias A. Zerhouni, head of the National Institutes of Health (NIH), are Muslims. American presidents have congratulated Muslims on religious holidays and often invite Muslim clergymen to important state functions, such as the funeral of former president Ronald Reagan.

Abstract Background The Emergency Room (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia. Methods This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome. Results The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57–5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85–89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65–51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70–133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23–0.38). Conclusions A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.

Abstract Background Emergency care continues to be a challenge, since patients’ arrival is unscheduled and could occur at the same time which may fill the Emergency Department with non-urgent patients. Triaging is an integral part of every busy ED. The Canadian Triage and Acuity Scale (CTAS) is considered an accurate tool to be used outside Canada. This study aims to identify the chosen triage level and compare the variation between registered nurses, pediatric and adult emergency residents by using CTAS cases. Method This study was conducted at King Abdulaziz Medical City,Saudi Arabia. A cross-sectional self-administered questionnaire was used, and which contains 15 case scenarios with different triage levels. All cases were adopted from a Canadian triage course after receiving permission. Each case provides the patient’s symptoms, clinical signs and mode of arrival to the ED. The participants were instructed to assign a triage level using the following scale. A non-random sampling technique was used for this study. The rates of agreement between residents were calculated using kappa statistics (weighted-kappa) (95%CI). Result A total of 151 participants completed the study questionnaire which include 15 case scenarios. 73 were nurses and 78 were residents. The results showed 51.3, 56.6, and 59.9% mis-triaged the cases among the nurses, emergency residents, and pediatric residents respectively. Triage scores were compared using the Kruskal Wallis test and were statistically significant with a p value of 0.006. The mean ranks for nurses, emergency residents and pediatric residents were 86.41, 73.6 and 59.96, respectively. The Kruskal Wallis Post-Hoc test was performed to see which groups were statistically significant, and it was found that there was a significant difference between nurses and pediatrics residents (P value = 0.005). Moreover, there were no significant differences found between nurses and ER residents (P value> 0.05). Conclusion The triaging system was found to be a very important tool to prioritize patients based on their complaints. The results showed that nurses had the greatest experience in implementing patients on the right triage level. On the other hand, ER and pediatric residents need to develop more knowledge about CTAS and become exposed more to the triaging system during their training.

Bronchial asthma is a major public health problem. The Saudi Initiative for Asthma (2012) reported that the prevalence of asthma in Saudi adults is not well known, but the overall prevalence in Saudi children ranged between 8 to 25%. The current study aimed to assess prevalence, identify triggers and risks and evaluate degree of control among Saudi children. A cross sectional study was conducted among secondary school students in the Al Majaridah governorate, Aseer region, Saudi Arabia using a structured questionnaire.. Responses were received from 792 students of both genders. Asthma prevalence was found to be 9.7%. Many asthmatic students report smoking and contact with animals as major triggers of asthma symptoms and more than two thirds of students had poor asthma control. In conclusion, most asthmatic students are not controlled and further studies of current health education available for students and families are required to explore why this is the case. Objectives: The current study aimed to estimate the prevalence, to identify triggers and risk factors of asthma and to assess the degree of control among Saudi children in the Al Majaridah governorate. Aseer region, Saudi Arabia. Methodology: This cross sectional study was conducted using a structured questionnaire which was distributed to all secondary school students in the Al Majaridah governorate during 2021. The questionnaire consisted of many parts; socio-demographics, risk factors, triggers of asthma and asthma control test questions. Data entry and analysis were made using SPSS. Results: Out of a total 1490 secondary school students, 792 students participated in this study giving a response rate of 53%. The mean age of the participants was 17 years and the majority of them were male (62.9%). The prevalence of bronchial asthma was 9.7%. Risk factors of asthma at home were animals or birds (7%), cockroaches (14%), heavy exercise (32%) and smoking (8%). More than two thirds of participants had poorly controlled asthma . Conclusion: The prevalence of bronchial asthma among students in the Al Majaridah governorate was similar to that in previous national studies. Most asthmatic students have poor control of their condition and intensive health education of students and their families is needed. Further studies are suggested to explore the reasons behind poor control of asthma among asthmatic students. Key words: Bronchial asthma, Aseer, Risk factors, Control

The occurrence of non-alcoholic fatty liver disease has exponentially increased worldwide. A considerable majority of cases advance to non-Alcoholic Steatohepatitis in the nonexistence of therapeutic measures, which increases morbidity and death. Because the initial phases of the illness are frequently clinically unapparent, the identification of non-alcoholic fatty liver disease frequently rests on biochemical and radiographic studies. Concentrated life modifications that result in weight loss are the mainstay of the disease's management. Therapeutic treatments that could be additional to lifestyle changes once essential for case managing comprise insulin sensitizers, antioxidants, incretin-based pharmaceuticals, cholesterol depressing mediators, weight reduction therapies, bariatric surgery, and liver transplantation. For non-alcoholic fatty liver disease to be managed more effectively and lessen its worldwide impact, research must be conducted continuously.

Background: Influenza is one of the infections in which a specific pattern is observed according to seasons which result in severe forms of disease. By providing regular and extensive quality in epidemiological studies, the surveillance system can help in reducing the threat to public health posed by influenza that eventually minimizes the effect of illness. They also help in reporting the health ministry about the relevant information as an aid to reduce the impact of disease on public health. Objective: To assess the incidence of seasonal influenza in Abha City, Saudi Arabia. Methods: This surveillance report conducted among citizens of Abha, Saudi Arabia, 2019. It is based on sentinel surveillance and case-based data collection of laboratory-confirmed cases through electronic health records. All data were obtained from the department of infectious diseases of public health department in Aseer health directorate. Results: The total reported positive cases for influenza viruses were 808 (22.30%) patients in the city of Abha for the year 2019, among them 435 males and 373 females (F= 9.5149; P=0.002038) which 665 (82.3%) were typed as influenza A and 143 (17.7%) as influenza B. (F= 674.46; P=0.001). The prevalence of the disease is commonly seen in the age group of 5-15 (42.35 %) with a mean age of 15.45±4.50 followed by 16 to 50 years age (37.45%) and 51-65 age group (10%). There was no death registered among these cases. In February maximum cases were found, whereas in June and July minimum cases were recorded. The influenza positivity rate showed one primary peak and three secondary peaks that were recorded in February and January, March and December. Conclusion: Importance of conducting effective epidemiological surveillance for influenza virus in various regions in Abha specially in winter season with a peak in the month of February.

Background: Headaches disorders have a significant burden on the world. Tension Type Headache is the most common type among primary headaches. Since medical students are exposed to a lot of stress, and it is associated with a tension-type headache, the importance of this study comes. This study aims to measure the prevalence of tension-type headache among medical students at Tabuk University 2020. Methodology: A cross-sectional study in Tabuk, Saudi Arabia was conducted. The study included medical students at the University of Tabuk in the academic years from 2nd to 6th grades during the calendar year of 2020. An adapted semi-structured self-administered questionnaire was retrieved from other validated questionnaires. The internal validity and reliability of the questionnaire were tested using Cronbach's alpha test and was highly reliable (25 items, α = .715). Both medical and research experts assessed the face and content validity. The data were coded, tabulated, and analyzed using the Statistical Package for the Social Sciences (SPSS, version 27). Results: The total number of the students was 380 (response rate, 78.6%). 55.22% were females, and 44.78% were males their mean age was 21.18 ± SD 1.78 years. Out of the 297 students, only 122 met the diagnostic criteria. The 1-year prevalence Tension Type Headache (TTH) included the three types: frequent TTH 67.2%, 18.0% infrequent TTH, and only 14.8% suffered from chronic TTH. The most common aggravating factors included studying stressors (82%), 68% of the participants reported daily activity interference, and 48.4% reported that headache aggravate with routine physical activities (e.g., walking or climbing stairs). The headache quality varied between throbbing/pulsating (54.9%), pressing/tightening (68.9%) and sharp/stabbing (10.7%). The median headache intensity was 5.25 at pain level score (IQR =2). Only 28% of the students sought counseling where the main analgesic used was Acetaminophen (74%). Many non-pharmacological therapies were practiced by the students to relieve headache, including sleep (60.7%), rest (63.1%) and caffeine (41.8%).23% of the medical students reported that they sought medical counseling to maintain their performance level. There was a statistically significant difference between the average age of medical students suffering from frequent and infrequent TTH, t(102) = 2.31, p = .023. Conclusion: Tension-type headache is a prevalent type of headache among Saudi medical students. Prevalence and aggravating factors in our study were comparable to previously reported literature. Future studies with large sample size may be required among all university students to define burden of the case in Saudi Arabia.

Abstract Background Carpal tunnel syndrome (CTS) is one of the most common nerve entrapments in the upper limb. In Saudi Arabia, few studies have investigated CTS in the general population. This study aimed to determine the association between personal factors and CTS. Methods A case-control study involved adults aged 18 and above. Cases were recruited from electrophysiology lab records as consecutive case series, while controls were individuals who were free of CTS symptoms according to the Boston Carpal Tunnel Questionnaire (BCTQ). The electronic medical records of participants were reviewed to obtain age, height, weight, medical conditions, and mobile numbers. Cases and controls were contacted via phone to complete a questionnaire that was designed based on previous literature. We used multivariate binary logistic regression to identify the personal factors significantly associated with CTS. Results A total of 95 cases and 190 controls were included. Most of the participants were female (84.2%) and Saudi (93%). Most of cases were above 45 years of age (73.7%), while 84.7% were 45 year – old or younger among the control group. Stratified logistic regression showed that performance of household chores was significantly associated with CTS. While physical exercise associated with decreased odds of CTS. Conclusions This study adds to the body of evidence on personal factors associated with CTS. However, the degree of differences in the age structure of the cases compared with the controls suggest that there is a considerable potential for residual confounding affecting the results. Trial registration number Not applicable.

Background: Drug-induced immune hemolytic anemia is a serious adverse reaction that may result from drug administration, especially in cases of glucose-6-phospate dehydrogenase (G6PD) deficiency. Objective: To report a case of acute hemolytic anemia in a 30-year-old Saudi male after receiving Semaglutide injection. Case Report: A 30-year-old Saudi male with G6PD deficiency presented to the Emergency Department of Aseer Central Hospital, Abha City, Saudi Arabia with acute onset of yellow discoloration of the eyes, palpitation, mild backache, fatigue, and dark urine. The symptoms started one day after receiving the second dose of Semaglutide injection. He looked pale and the sclera were slightly icteric. Laboratory investigations showed high serum levels of liver enzymes and the total bilirubin. The RBCs count as well as the hemoglobin and the hematocrit were low, while reticulocyte count was high. The diagnosis was acute hemolytic anemia, most probably triggered by a recent Semaglutide injection. Following the discontinuation of Semaglutide, his clinical condition improved. Conclusions: G6PD deficiency should be considered in all clinical settings, and the hemolytic conditions that can possibly be precipitated by drugs not well known to cause hemolysis. Screening of newborn infants to early detect G6PD deficiency early is highly recommended, especially in those with positive family history of G6PD. Key Words: Semaglutide, Hemolytic anemia, G6PD deficiency, Case report.

Background: Most of the available literature on grafts being contaminated by dropping them on operating room floors has focused on bones and tendons. By contrast, few studies concern skin grafts, with no existence of rib cartilage grafts. However, due to the lack of protocols when such an incident occurs, the results in the literature are incompatible. Most of the studies recommend managing the situation by sterilizing the graft with antiseptic agents and completing the surgery as well as avoiding obtaining another graft, which might increase morbidity. Case Presentation: Here, we report a case at the rhinoplasty clinic at King Abdullah Medical City in Makkah, Saudi Arabia. The case is of a 30-year-old male patient who complained of a saddle nose with a loss of tip support and severely deviated septum grade 5 caused by a history of trauma. The patient also had symptom-free pectus excavatum that had not been corrected surgically. Otherwise, the patient had a good body build with no family history or past medical/surgical history. Conclusion: The patient underwent reconstructive surgery to the nose using rectus muscle fascia and a rib cartilage graft. During the operation, the cartilage was accidentally dropped on the floor. Due to the patient&apos;s chest configuration, harvesting a new graft was difficult. Thus, the same graft was used after decontamination. Clinicians who treat patients in similar clinical circumstances in the future may benefit from our experience.

Aims: This study aimed to determine if there was an association between head lice infestation and anemia among female primary schools students. Study Design: Case-control study. Place and Duration of Study: Holy Makkah, Saudi Arabia between August 2020 and November 2020. Methodology: We conducted a case-control study by comparing hemoglobin levels among study subjects with and without head lice infestation. Female students at 6 randomly selected primary schools were examined for the presence of head lice. Hemoglobin levels were obtained from each study subject; both those with and without head lice. Selected characteristics of study subjects were recorded and examined to determine associations between those factors and anemia. Results: A total of 82 subjects were included in the study; 44 subjects with head lice. The average (± standard deviation) age of subjects was 11 (± 2) (range: 6-11) years. We found a significant (p<0.028) association between the presence of head lice and hemoglobin level, the OR= 2.036 at 95% confidence interval 0.23 to 18.009. The mean of hemoglobin in subjects with lice was 13(±2) while the level in subjects without lice was 14.8(±2). Other factors significantly associated with the level of hemoglobin were being aged 10-11 years (p<0.05) and having a non-working mother (p<0.05). Conclusion: In our study we found a significant association between head lice and level of hemoglobin among study subjects. Further studies are needed to determine the reason of this association in order to determine the appropriate management and prevention of this problem.

There is no doubt that the traffic problem is one of the problems faced by universities in general، and in different intensities for roads، intersections and parklands. The negative effects of traffic congestion and bottlenecks are clear; they include extension of long waiting lines and increasing the time of transport with the consequences of ill effects. The effective solutions placed to resolve these problems need specialized studies relying on scientific methods for collecting and analyzing relevant data, and drawing effective conclusions, recommendations, and solutions. The main purpose of this study is to analyze the problems of traffic congestion in universities, with realistic application to King Abdulaziz University in Jeddah as a case study and to provide the best solutions to achieve fluent flow of traffic in the future. Due to the complexity of the problem and its huge data، and to facilitate the analysis process, the problem has been divided into three main sections: main gates، Interior roads and intersections، and car parking. The data is collected by four different ways: the use of automatic counting equipment which records the number of vehicles that pass in each hour during the period of counting manual method of counting through registration in a prepared form so as to record the number of vehicles located in the parking place during the each hour، interviewing and a survey of a random sample of students, faculty members, administrative employees, and university passers-by and visitors, as well as observing and recording traffic problems in some places of the university. It has been possible to reach a wide range of recommendations for gates، roads، and parking areas, to achieve the desired goals of ease flow of traffic now and in the future. The proposed solutions takes into account the simplicity, low cost, and non-recourse to destructive changes such as complete changing the place of the university، or demolition of all buildings and re-planning. The study gives also a set of conclusions that can be followed as an approach to study، analyze and solve the general traffic problems in other universities.

Abstract Background Medical research is a central part of any residency training. In view of the new Saudi orthopedic committee promotion regulation that mandates each resident to participate in a research project, the challenges that stand in the way of completion of substantial research within surgical residency must be investigated. The aim of this study was to assess the practice, attitudes, perception, and limitations associated with research among residents in the Saudi orthopedic program in the central region. Methods A cross-sectional study was conducted between June and July 2020 using an online-based survey. The total number of study participants was 128 orthopedic residents out of the 191 residents enrolled in the central region program. Data were analyzed, and descriptive statistics in the form of frequency and percentage were determined, analytical tests were performed with P < 0.05 being statistically significant. Results Most residents (95 %) participated in a research project during residency. Most projects (53.10 %) were case reports followed by retrospective studies (48.40 %). The majority (79.70 %) did not attend a research methods course during residency. Experience in research differed significantly (P < 0.05) by age, residency year, and center. The mean involvement score was significantly higher among males at 3 (± 1) than among females at 2 (± 0) (P < 0.001). Only 40.60 % have access to orthopedic journals, and the same percentage (40.60 %) knew how to Critique original articles. There was a statistically significant difference in the accessibility score according to the training center. Lack of faculty support and mentorship were the main barriers to medical research at 62.50 and 39.10 %, respectively. A total of 68.80 % reported that funding was not available through their institutes. Conclusions In Saudi Arabia, the level of meaningful clinical research and publications by orthopedic residents is still low. The results of this study should be taken into consideration before the implementation of the new promotion criteria in the centers under the umbrella of Saudi orthopedic committee.

Abstract Objectives The study aimed to assess the relationship between coffee intake, obstructive sleep apnea risk (OSA), and glycemic control among patients with diabetes mellitus. Results There were 110 patients with diabetes and 96 healthy control subjects (matched for age and sex) attending a diabetes center زinTabuk, Saudi Arabia during the period from June 2018–October 2019. Stop-Bang questionnaire was used to assess OSA risk, and Epworth Sleepiness Scale to investigate daytime sleepiness. OSA risk and daytime sleepiness were higher among patients with diabetes compared to controls (4.34 ± 1.61 vs. 2.86 ± 1.24, and 8.31 ± 4.40 vs. 6.39 ± 3.70 respectively, P < 0.5), while coffee consumption was not (4.64 ± 3.95 vs. 3.45 ± 3.06, P > 0.05). Women with diabetes were younger with short duration since the diagnosis of diabetes and consumed less coffee compared to men, P < 0.5. A negative correlation was found between coffee consumption and the duration of diabetes, while no correlation was found between coffee intake, the glycated hemoglobin, OSA risk, sex, and daytime sleepiness. Daytime sleepiness and OSA risk were commoners among patients with diabetes, they were not correlated with coffee consumption which was negatively correlated with the duration since diabetes diagnosis. Further larger multi-center studies investigating coffee intake among patients newly diagnosed with diabetes are recommended.

Abstract Background Cardiovascular diseases are the leading cause of death and comorbidity worldwide. High blood pressure and resting heart rate are risk factors (or vital signs) critical to cardiovascular health, patient safety, and medical management. Physiotherapists play a fundamental role in risk factor identification, early diagnosis, and subsequent management of cardiovascular disease. To date there is limited research in Europe investigating the level of knowledge and skills possessed by physiotherapists regarding cardiovascular disease screening. Three studies previously observed inadequate vital signs screening behaviors of physiotherapists practicing in the United States and Saudi Arabia. The primary aim of this study was to investigate cardiovascular knowledge and screening practices among Italian physiotherapists, according to the current practice recommendations. Methods A Cross-Sectional Survey was developed adapting two previous surveys. The survey was administered to members of the Italian Physiotherapy Association. Chi squared test, Mann-Whitney test or Kruskal-Wallis test were used to study differences among subgroups and question responses. Results The required sample size was met with total of 387 Italian physiotherapists completing the survey. 80% consider relevant cardiovascular assessment. However, 72.2% were not familiar to guidelines recommendations and only 50% screen vital signs routinely. Their knowledge of normative blood pressure (high-normal, 16%; hypertension, 12%) and heart rate values (bradycardia, 24%; tachycardia, 26%) were low. Although participants reported being skilled for blood pressure measurement (quite sure, 52%; sure, 27%), their adherence to guidelines is low (baseline measurement on both arm, 25%; 3 repeated measures, 46%). Only 27.8% reported to measure exercise related BP and 21.3% of them understood the concept of exaggerated BP. No significant differences between subgroups were found. Conclusions Our study revealed that a concerning proportion of Italian physiotherapists are not versed in fundamentals of properly performing cardiovascular screenings. This lack of knowledge is present across the profession and may impact on appropriate triage and management. The poorly executed screening has the potential to negatively impact the patient and the practitioner. Given the absence of Italian guidelines, we produced and implemented three infographics for public use, which have the dual objective of raising awareness about this subject and providing practical resources for everyday practice.

Introduction: Access to emergency healthcare services and specialist care – particularly paramedic services – is more restricted in the rural and remote areas of Australia, and this disparity is amplified further as remoteness increases. This review aims to investigate the availability of current research regarding both the expanding nature of paramedicine roles in rural environments, and the impacts of rurality on the quality of out-of-hospital care provided to patients. Methods: Arksey and O’Malley’s six-step methodological approach was used to perform a scoping review to assess the availability of literature. Key words including paramedic*, regional, rural, remote and role were inputted into the search engines Scopus, CINAHL and PubMed. Titles and abstracts of the 864 results were screened by all authors and inclusion/exclusion criteria applied, resulting in 13 remaining articles. Results: The final 13 articles comprised differing data collection types and methodologies from nine separate studies conducted in either Canada, Australia, the United Kingdom, the United States, Saudi Arabia or Qatar. Approximately 2.5 million patients, 534 paramedics, 331 other healthcare professionals and 35 case studies were included in the total combined results of these studies. Conclusion: Rural communities demonstrated increased mortality rates in out-of-hospital patients due to several factors including rostering, specialist service locations and limited resource availability. Factors which were beneficial to the outcomes of patients in rural settings included enhanced paramedic scopes of practice, the implementation of community paramedicine programmes and wider roles within the community for paramedics. A lack of research on the exact nature of these changing roles in rural paramedicine is evident.

The aim of this study is to detect the magnitude of bad nutritional habits and assess the strength of association between T2DM and late-night dinner and skipping breakfast in Medina, Saudi Arabia. Methods: A case control study was conducted at Diabetic centre and PHC centres. The cases were Early-onset T2DM (30–45 years of age). A self-administered questionnaire consisted of three parts including socio-demographic information, eating behaviors and questions focusing on DM. Data were analyzed by using SPSS version 28 statistical package software. Results: A total 47 cases with diabetes mellitus type 2 and 188 controls were included. Cases were more prone to be obese with median BMI 30.5. Overall, 74.5% of cases were reported to be physically inactive. 72.4% of cases were skipping breakfast weekly as compared to 65% of controls [p-value 0.015]. Smoking, frequency of exercise, BMI and frequency of eating of fast food were found to be significant risk factors for developing T2DM with OR 4.0, 3.6, 5.5 and 2.0 respectively. Conclusions: Our data confirmed that skipping breakfast and late-night dinner were prevalent, and many risk factors associated with diabetes mellitus have been identified. Therefore, we recommend introducing health education programs to address misconceptions towards prevention and better control of diabetes mellitus. Keywords: Diabetes mellitus type 2, skipping breakfast, late-night dinner.

Introduction: The current study aimed to assess students’ competency of the Faculty of Medicine, Makkah region Saudi Arabia in interpreting common laboratory investigations like Complete Blood Counts. Methods: The current cross-sectional, quantitative and exploratory study was carried out at the Faculty of Medicine, Rabigh, King Abdulaziz University (KAU), Jeddah, from April 1 to April 20, 2022. An online questionnaire was circulated via various social media like Facebook, Twitter, and WhatsApp. Results: A total of 1,010 respondents participated in the survey, representing an overall response rate of 70%. Among all the respondents, females were 677 (67%) while males were 333 (33%). There were 277 (27.4%), 479 (47.4%), and 254 (25.1%) students from the fourth, fifth, and sixth years, respectively. For most of the statements, more than 70% of students responded correctly, but particularly for three of the questions, students’ correct responses were 561 (55.5%), 518 (51.3%), and 491 (48.6%), which were not up to the mark. A gender-wise comparison showed that the percentage of correct answers given by female students was significantly higher than that of male students for all statements (p< 0.001). For most of the indices, more than 70% of students responded correctly, while for four questions, students’ correct responses were not up tothe mark. Comparison between students’ gender revealed that, apart from two, the percentage of female students who correctly interpreted the indices was significantly higher than that of male students (p 0.001). In the results of all participants’ responses to the clinical scenario interpretation the female students performed significantly better in scenarios 1 and 2 (p 0.001). Conclusions: Overall, our study participants’ comprehension of CBC values and interpretation of the case scenarios was adequate. On the other hand, female students demonstrated better conceptual understanding than male students. We recommend improving assessment systems to help students expand their interpretation skills. Key words: Complete Blood Count, interpretation, medical students, Saudi Arabia

Objectives: To investigate the blood plasma levels of Fetuin-A protein in children with Autism Spectrum Disorder (ASD) and healthy controls that could offer novel diagnostic biomarkers of disease development in ASD. Another objective was to investigate the severity of autistic children by Childhood Autism Rating Scale (CARS) and Short Sensory Profile (SSP). Methods: This case control study was carried out at Autism Research and Treatment (ART) Center, King Saud University, Riyadh, Saudi Arabia, from October 2019 to February 2020. Plasma concentration of Fetuin-A was analyzed by enzyme-linked immunosorbent assay (ELISA) in ASD subjects (n=46) and normal controls (n=44). Correlation among Fetuin-A levels, CARS and SSP was established by Spearman’s correlation coefficient (r). Results: Overall, autistic children had significantly (p= 0.0.02) lower Fetuin-A concentration [50.76 (22.2-68.5) ng/ml] than those of healthy controls [53.7 (35.6-99.7) ng/ml] [median (interquartile range)]. Children with mild to moderate autism (n=24, 52%) also showed significantly lower Fetuin-A levels [50.0 (30.0-68.2) ng/ml], (p =0.02} than healthy controls [53.7 (35.6-99.7) ng/ml] [median (IQR)]. However, there was no significant change (p = 0.71) observed between the Fetuin-A levels of children with severe autism [51.8 (22.2-68.5)] ng/ml, mild to moderate autism [50 (30-68.2)] ng/ml [median (IQR)] and healthy controls (p=0.12). Also no significant correlations between Fetuin-A, CARS and SSP were observed (CARS, r= 0.024, p=0.88; SSP, r= -0.003, p=0.98). Conclusion: Overall the low Fetuin-A plasma values in ASD subjects, most likely show that Fetuin-A could be associated in the physiology of autism. Further studies with larger patient and control cohorts will be necessary to determine whether Fetuin-A can be used as a biomarker for ASD. doi: https://doi.org/10.12669/pjms.37.4.4032 How to cite this:Al-Ayadhi LY, Alghamdi FA, Altamimi LA, Alsughayer LY, Alhowikan AM, Halepoto DM. The possible link between Fetuin-A Protein and Neuro-inflammation in Children with Autism Spectrum Disorder. Pak J Med Sci. 2021;37(4):---------. doi: https://doi.org/10.12669/pjms.37.4.4032 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.