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Research in western countries concludes that children and adolescents are exposed to multiple forms of online risks and harms. However, in the context of Saudi Arabia, research in online safety education is lagging. Currently, online safety education is generic and not research informed. Hence, this exploratory study seeks to generate a qualitative understanding of online risks and harms experienced by Saudi children, adolescents, and parents as well as online safety strategies. Using a semi-structured interview, this study explores the views of 15 children (12–15 years) and 10 parents. Interpretative Phenomenological Analysis (IPA) yielded four key themes: Negotiating the Promise and Peril of the internet, Living with the Shadows of the Online World, Psychological, and Physical Health Consequences, and Navigating Safety in a Digital Landscape of Uncertainty. While the benefits are clear (e.g., education and socialisation), children and parents have shared worries about cyberbullying, aggression, and exploitation. Internet addiction and isolation are notable consequences along with vision impairment and obesity. Children’s online safety practices are reactive, e.g., blocking and deleting risky content/behaviour, while parents share their struggles in monitoring children online. Online safety education, or the lack of it, is to blame. Children’s and parents’ limited awareness of online risks and poor online safety practices need to improve in Saudi Schools and households; there is an urgent need for further research and adequate implementation of systematic online safety education.

This thesis is based on empirical fieldwork that consisted of two Interpretative Phenomenological Analysis (IPA) studies investigating the acculturation experiences of Saudi international students in the UK. It further explored the identity negotiation process and perceived consequences on their sense of self and identities by combining the original acculturation framework from Berry (1997, 2011) with the Dialogical Self Theory of Hermans (2001). The aim of Study One was to examine transitions when moving to and studying in the UK for Saudi Arabian students focusing on the experiences that students reported as challenges. A sample of 8 Saudi international students studying at a university in South East England was used to collect data. Using IPA method, the analysis identified 14 primary themes relating to the Saudi Arabian students' experiences of the UK. Drawing on Berry's model (1997; 2011), the themes were organized around two stages of transition: 1) pre- moving to the UK and 2) arriving and living in the UK; and a third major theme emerged in the data, which was the impact of change on self-development. The findings reinforced experiences that are common to all international students, but in particular, they highlight experiences that were very specific to the sample of Saudi students studied. The findings showed that Saudi students experienced various challenges and difficulties. However, Study One also reported self-development as the outcome of students' acculturation. Further, the participants addressed the dialogue in identity positions linked to their home culture (Saudi) and being in the UK. The novel findings were used to guide the development of Study Two. The aim of this study was to understand how Saudi students negotiated the demands of different identity positions. This study involved a sample of 11 Saudi international students studying at universities in South East England. This involved an expansion of the theoretical framework by combining the original acculturation framework from Berry (1997, 2011) with Dialogical Self Theory from Hermans (2001) to obtain a more in-depth understanding of how Saudi students gave meaning to the idea of being Saudi students in the UK. Using IPA (Smith et al., 2009) and DST (Hermans, 2001), combining both phenomenology and interpretation, the analysis identified three distinct I-positions: I-as a Saudi in the UK, I-as a Saudi Arabian national identity, and Identity negotiation processes among these positions. The findings illustrated key areas of dialogical self experience of Saudi students. In this study, the dialogical self of the participants was engaged in negotiating I-positions and repositioning processes, which were dependent on and prompted by the participants' goals of studying abroad and their preferred future. The original and important findings generated by this research have distinct implications for the acculturation of Saudi international students and identity negotiations and contribute to the literature on cross-cultural experiences and international students' issues. This research contributes to helping prospective and current Saudi students to become more informed regarding the experiences they may encounter when studying in the UK.

Hypertension causes microalbuminuria, which if left uncontrolled could progress to kidney damage. Antihypertensive treatment primarily aims at controlling blood pressure (BP), but is also shown to control urine albumin excretion. This renoprotective role of antihypertensive medications consists of halting or reverting albuminuria progression. A national Kingdom of Saudi Arabia (KSA), multicenter, observational, longitudinal study (RATIONAL), evaluated the correlation between BP control and microalbuminuria evolution over 1 year. Adult hypertensive patients with kidney damage were enrolled, after giving written consent. Of 409 patients, 60% had uncontrolled BP at baseline, down to 34% at 12 months. Over 80% of patients were on mono or double antihypertensive therapy, and angiotensin-receptor blockers (ARB) topped the list of medication classes. Albumin-creatinine ratio (ACR) significantly decreased throughout the study, indicating that BP control is paramount to prevent target organ damage. BP change most strongly correlated with ACR change upon triple therapy (ARB + calcium channel blocker + β-blocker). Importantly, 25% (at 6 months) and 38% (at 12 months) of patients reverted back to normoalbuminuria, mostly upon renin-angiotensin system blockers. Around 80% of study patients had also diabetes, a common condition in KSA, which significantly hindered achievement of normoalbuminuria at 12 months. A modest but solid correlation between BP control and ACR reduction was identified. Results underline proper BP management in KSA and success of antihypertensive treatment in reverting microalbuminuria or delaying its progress. The study duration might be insufficient to reflect conclusively the beneficial effect of longer-term BP control on microalbuminuria evolution.

Chest pain in pediatric patients is a common concern in pediatric emergency departments (ED). In most cases, benign conditions are related to noncardiac causes, and only a minority of the cases are caused by heart disease. This research aimed to evaluate the causes and characteristics of chest pain among children in a pediatric emergency department. This retrospective study evaluated children younger than 14 years of age who presented to the emergency department of a general pediatric hospital in the Eastern area of Saudi Arabia with non-traumatic chest pain between 2017 and 2022. The data included socioeconomic information, physical examination findings, and the results of basic investigations, such as chest X-ray and electrocardiogram. The Chi-square test was performed to compare various etiologies, with a 5% significant level. The study evaluated 310 patients with a mean age of 9.1±2.7 years. The majority of children presenting with chest pain had normal physical examinations, except 3.3% who showed respiratory and cardiac findings. The diagnostic tests indicated pneumonia in 2.9% and arrhythmia in 2.1% of children. Most patients were discharged with a diagnosis of idiopathic or muscular chest pain. The majority of patients (95%) were treated symptomatically in outpatient settings, with just one patient requiring hospitalization. The most common cause of chest pain prompting a child to visit the ED was idiopathic chest pain. Therefore, this study highlights the significance of obtaining a comprehensive medical history and physical examination to reveal important clues and help avoid unnecessary tests.

The implantable cardioverter-defibrillator (ICD) is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region. Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates. Fifteen centers in six countries are enrolling patients (Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar). Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of ≤150 devices, and pulse generator replacements constitute <30% of implants in the majority of centers. Enrollment started in December 2013, and accrual rate increased as more centers entered the study reaching an average of 98 patients per month. Gulf ICD is the first prospective, observational, multi-center, and multinational study of the characteristics and, the outcomes of patients receiving ICDs in the Arab Gulf region. The study will provide valuable insights into the utilization of and outcomes related to ICD therapy in the Gulf region.

Implantation of specifically designed left ventricular (LV) lead is a relatively complex procedure that depends on the anatomy of the coronary veins, available instrumentation, and experience of the operator. In patients with dilated cardiomyopathy (DCM) tortuosity of the selected branch of coronary sinus (CS) leads to difficult or failed LV placement. A case study of a 45-year-old woman with DCM requiring lead placement is presented here. To plan for proper LV lead positioning, CS angiography was obtained through right femoral vein approach with preshaped long sheath (SJM, SL3) and occlusive balloon. For successful implant of LV lead, with no viable alternatives available, the tortuosity of the lateral and posterolateral branch were overcome by advancing and inflating the balloon in the main CS to deflect LV lead into the target branch. A unipolar LV lead (Medtronic 4193) was finally placed in a true posterolateral position with excellent sensing and pacing threshold without phrenic nerve stimulation.