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Heart failure (HF) is a progressive, multifaceted condition characterized by complex pathophysiological mechanisms, including chronic inflammation, which contributes significantly to disease onset and progression. Despite advancements in pharmacological therapies, such as angiotensin-converting enzyme inhibitors and β-blockers, HF remains associated with high morbidity and mortality. Inflammatory cytokines have emerged as potential biomarkers for HF, offering insights into disease mechanisms, risk stratification, and therapeutic responses. However, their clinical utility is hindered by analytical variability, pre-analytical challenges, and limited reproducibility across studies.This review explores the role of inflammatory cytokines in HF, evaluating their pathogenetic significance, analytical performance, and prognostic value. Biomarkers such as TNFα, IL-6, sTNFR1, and gp130 are assessed for their ability to enhance diagnostic precision and predict adverse outcomes. Furthermore, we examine the limitations of current cytokine assays, including sample stability, diurnal variation, and lack of standardization, which affect their transition into clinical practice. While natriuretic peptides and cardiac troponins remain the gold standard for HF biomarkers, multimarker approaches incorporating inflammatory cytokines may provide a more comprehensive understanding of HF pathophysiology.The findings underscore the need for robust, standardized methodologies and novel biomarkers beyond established pathways. These efforts will enhance HF management by improving risk stratification, guiding personalized treatment strategies, and advancing our understanding of inflammatory processes in HF progression.

Floods are one of the main damaging physical catastrophes, inducing economic losses and human casualties worldwide. The Eastern Mediterranean region is exposed to devastating flood events annually, with catastrophic consequences due to the complexity of the physical and human geographical characteristics. In this analysis, the performance of four ensemble machine learning algorithms (ML), that is support vector machine (SVM), random forest (RF), artificial neural network (ANN) and extreme gradient boost (XGBoost), was compared and tested in mapping flood susceptibility in the Eastern Mediterranean region. In the Baniyas River basin in western Syria, 1,100 flood events with 20 flood-driving factors were relied upon to achieve the goal of this assessment. The multicollinearity test results showed that all selected factors can be incorporated into the modelling process. Additionally, all the applied algorithms showed reliable and accurate performance in modeling flood susceptibility; however, the XGBoost algorithm achieved the strongest performance compared to other models with an AUC value of 0.98. Overall, the current results guide urban planners and land managers in increasing the quality of sustainable development practices and enhancing community resilience to flood risk in the study area.

This study aimed to evaluate the static and dynamic pupil changes, and light sensitivity following a single dose of low-dose atropine at concentrations of 0.01%, 0.025%, and 0.05% over a 24 h period. Healthy young adults (20–22 years; n = 25) participated in this randomized, double-blind study. Each participant received one of three atropine concentrations in a masked fashion. Baseline mesopic and dynamic pupil sizes were measured at various post-instillation intervals (5 min, 30 min, 1 h, 2 h, 4 h, and 24 h). A minimum 48 h washout period was observed between treatments. Subjective light sensitivity was assessed using the Visual Light Sensitivity Questionnaire (VLSQ-8) at 24 h. All atropine concentrations caused significant pupil dilation (p < 0.001), with the 0.05% concentration producing the greatest dilation (peak mesopic size: 7.4 mm, p < 0.001) and the slowest recovery at 24 h (6.4 mm, p < 0.001). The dynamic pupil constriction range was most restricted with 0.05% (1.7 mm, p < 0.05), compared to 0.025% (2.2 mm) and 0.01% (2.6 mm). Subjective symptoms, including light sensitivity and glare, followed a dose-dependent pattern (p < 0.05). In 60% participants, 0.05% caused the most symptoms, while in 70% participants, 0.01% caused the least. Despite significant pupil dilation, the pupil center coordinates did not shift significantly along the horizontal or vertical axes (p > 0.05). Low-dose atropine induced dose-dependent pupil dilation and light sensitivity; 0.05% atropine caused the most pronounced effects. These findings underscore the importance of tailoring the atropine dosage to balance its efficacy and tolerability. Further studies are needed to explore the long-term impact of repeated dosing on pupillary behavior and subjective symptoms.

Floods are considered one of the most common natural hazards in the Eastern Mediterranean. In western Syria, floods annually cause dozens of casualties with massive destruction of infrastructure and agricultural land. Moreover, the consequences of the war in Syria increased the amount of losses due to the complete absence of administration components at the regional and administrative level. Flood susceptibility mapping represents a crucial basis for creating flood management and mitigation strategies. The current investigation aimed to delineate a flood susceptibility map in the Baluta river basin, western Syria, using the integration of the Analytical Hierarchy Process (AHP) approach and the Geographical Information System environment. To achieve this goal, nine factors affecting the flood occurens were selected, namely: rainfall, elevation, slope, Topographic Wetness Index, drainage density, distance from the river, soil resistance, Land Use/Land Cover and lithology. Additionally, the spatial distribution of 162 flood events was determined as a validation dataset for the accuracy assessment process, which was carried out using the Area Under the Curve (AUC). The results indicate that more than 28% of the area of the study area is considered high and very high flooding hazard. These areas are located in the central and northwestern parts of the study area along the river courses. These areas are formed by floodplains that are characterized by a high frequency of flood events annually. The AUC value of 0.88% indicates the flood susceptibility map’s reliable and objective predictive ability produced using AHP. Overall, the approach applied in this evaluation represents a constructive tool for land use planners and policymakers to create spatial management strategies for flood risk in the environmental rehabilitation phase in Syria.

Background: Renal stone disease is a common urological condition considered to be greatly affected by lifestyle, dietary practices, and hydration status. With the rapid advancement and remarkable rise in digital communication, social media has become an important source of health information. However, little is known about its effects on raising public awareness of dietary and fluid-related risk factors for kidney stone formation, particularly in Middle Eastern populations. Aim: We aimed to evaluate the impact of social media platforms on public awareness of dietary habits and fluid consumption in relation to kidney stone prevention. Methods: A cross-sectional survey was applied to 980 adults with varying demographic characteristics. Data on social media use, dietary and fluid knowledge, and attitudes toward kidney stone prevention were collected through structured questionnaires. Statistical analyses, including regression and mediation models, were employed to identify predictors of awareness and explore pathways linking social media use to knowledge and attitudes. Results: Among the 980 participants (mean age = 29.9 ± 11 years; 55.4% males), 69.9% held university degrees, and 7.2% had a history of kidney stones. The overall awareness of kidney stone prevention varied, with most of the participants recognizing the protective role of adequate hydration (67%) and the adverse impact of soft-drink consumption (73.2%), while knowledge of dietary contributors such as animal protein and tea was limited. Greater knowledge and more appropriate attitudes were associated with older age, female gender, following healthcare professionals, and engagement with medical websites, YouTube, and TikTok. Mediation analysis revealed that social media influenced awareness indirectly through improvements in knowledge and attitudes. Conclusions: This study reveals that the digital environment shapes both public knowledge of and attitudes toward kidney stone prevention, though critical knowledge gaps persist regarding complex dietary factors. Mediation analysis indicated that the digital influence is likely channeled through improvements in knowledge and attitudes. We emphasize that source credibility is paramount; relying on official medical websites and following health professionals were the most effective strategies for boosting awareness. Therefore, expert-led educational strategies must be integrated into public health protocols.

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

Background Most of the medical schools in Saudi Arabia are currently evolving their curricula in accordance with the most recognized medical education trends worldwide. Undergraduate medical school’s curriculum should be compatible with community health needs. Therefore, the study aims to explore the current contents of Saudi undergraduate medical curricula and to check if the core topics that were internationally recognized were implemented in their curriculum. Methodology An online questionnaire was designed and sent to 37 deans of medical schools in Saudi Arabia. The deans or the vice-deans in charge of the curriculum were asked to complete the pre-designed questionnaire, which assessed the status of inclusion of the core topics in the curriculum of their affiliated schools. Each listed core topic was evaluated according to five options for each subject: not included, separate required course, part of the required course, separate elective course, and part of an elective course. Results Twenty four out of 37 (65%) Saudi medical schools completed the survey questionnaire. Almost all core topics, such as communication skills, evidence-based medicine, patient safety, professionalism were included in the curricula of Saudi medical schools as separate required courses or as part of required courses or elective courses. Complementary and alternative medicine and the history of medicine were the topics least taught in Saudi medical colleges, as 25% of the schools did not include them in their curricula. Conclusion The majority (65%) of the internationally recognized core topics were included in the Saudi undergraduate medical curricula. Evidence-based medicine, complementary medicine, the Saudi healthcare system, patient safety, and professionalism/medical ethics should be part of compulsory credited courses in all Saudi undergraduate medical curricula.

Background: The frequent occurrence of medical errors threatens the quality of healthcare in Saudi Arabia (KSA). Although electronic health record (EHR) systems can help to minimize such errors by improving the quality of clinical documentation, there is low EHR adoption in KSA. There is insufficient evidence available in KSA to enhance understanding of EHRs’ benefits for healthcare quality. Aim: This study aims to provide evidence that EHR can improve healthcare quality in KSA by measuring its impact on the quality of clinical data. Method: This study was conducted at a Hospital in Madinah, KSA. It followed a quantitative methodology and a quasi-experimental design and depended on a sample of 578 records, which included 289 paper and 289 electronic records. Data were collected using the CRABEL (CRAwford-BEresford-Lafferty) score, a tool named after its creators, which is used to measure medical record quality in four elements of documentation: “initial clerking”, “subsequent entries”, “consent” and “discharge summary”. The CRABEL scores overall were recorded out of 100 for both paper and electronic records to evaluate the impact of EHR. The Statistical Package for the Social Sciences (SPSS), version 25 was adopted to analysing the study's data. Result: The overall quality of clinical documentation improved significantly after EHR adoption from 63.94% (63.49-64.42 95% confidence interval (CI)) to 90.39% (90.11-90.65, 95% CI) (t-test P = 0.001). The differences were also detected significantly in all categories of CRABEL score between pre- and post-EHR adoption. Conclusion: EHRs improve clinical documentation quality and should be adopted in clinical practice.

Understanding of periodontal diseases and their broader health relevance is considered an important aspect to achieve better self-awareness of health. Therefore, this review aimed to explore the awareness levels of periodontium diseases among various locations and populations in Saudi Arabia. A comprehensive approach was used among multiple databases and search engines, including PubMed, Web of Science, Scopus, and Google Scholar, focusing on awareness levels among the general population and vulnerable groups (such as diabetic patients and pregnant women), in addition to healthcare providers. The synthesis of the review follows the hermeneutic approach, which involves identifying themes through repeated reading and interpretation of the findings. The review shows the urgent need for culturally sensitive and comprehensive oral health educational programs targeting the general population, vulnerable groups, and healthcare providers in Saudi Arabia. Integration of educational oral health programs into the routine practice of maternal health management and chronic disease clinics, along with prevention campaigns and healthcare provider training and development, is essential to improve the level of awareness of periodontal diseases.

Objectives: This study aimed to assess the knowledge, attitude and care-seeking practices of parents towards childhood ear infections in Riyadh, Saudi Arabia. Methods: This quantitative cross-sectional study was conducted in Riyadh, Saudi Arabia, between April and June 2018. An online survey was sent to a random selection of parents who were ≥18 years old with children of ≤10 years old. Associations between parental knowledge, attitude, care-seeking practices, socioeconomic status, level of education and age were assessed using the chi square test and logistic regression analysis. Results: A total of 782 subjects participated in this study (response rate: 78.2%). Most respondents were knowledgeable (76.2%), had a positive attitude (78.9%) and had positive care-seeking practices (89.5%). There was a statistically significant difference on both bivariate and multivariate analyses (P <0.05) between parental care seeking practice and knowledge. Parents who sought modern approaches to treatment were found to be almost nine times more likely to have a good attitude towards ear infections than those who did not seek treatment (odds ratio = 8.907, 95% confidence interval = 2.655–34.928; P <0.001). A statistically significant relationship was found between good care-seeking practice and age, as well as socioeconomic status (P <0.05 each). Conclusion: This study showed that knowledge, attitude and practice regarding paediatric ear infections were positive in the majority of parents in Riyadh, Saudi Arabia. Future studies should assess other factors that enhance the knowledge, attitude and practices regarding ear infections.