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Multiple myeloma (MM) is the second-most common cancer among hematological malignancies. Patients with active disease may experience several comorbidities, including renal insufficiency and asthma, which may lead to treatment failure. The treatment of relapsed or refractory MM (RRMM) has been associated with multiple factors, causing a decline in progression-free survival as well as overall survival with subsequent lines of therapy. Data about the characteristics of this group of patients in the Greater Gulf region are lacking. The primary objective of this study is to describe the disease characteristics and various treatment approaches or regimens used in the management of patients with RRMM in the Greater Gulf region. We will conduct a regional, retrospective study collecting real-world and epidemiological data on patients with MM in countries of the Greater Gulf region. Medical records will be used to obtain the required data. Around 150 to 170 patients' records are planned to be retrospectively reviewed over 6 months without any cross-sectional or prospective intervention. Cases will be collected from Saudi Arabia, the United Arab Emirates, Kuwait, Oman, and Qatar. Descriptive as well as analytical statistics will be performed on the extracted data. The calculated sample size will allow us to estimate the percentages of RRMM cases with acceptable precision while complying with the challenges in light of data scarcity. We will obtain a comprehensive description of the demographic profile of patients with MM; treatment outcomes; the proportion of patients with MM with renal impairment and asthma, chronic obstructive pulmonary disease, or both at the time of diagnosis and any subsequent point; and data related to treatment lines, regimens, and MM-associated morbidities. Patient medical records were reviewed between June 2022 and January 2023 for eligibility and data extraction. A total of 148 patients were eligible for study inclusion, of whom 64.2% (n=95) were male and 35.8% (n=53) were female. The study is currently in its final stages of data analysis. The final manuscript is expected to be published in 2024. Although MM is a predominant hematological disease, data on its prevalence and patients' characteristics in the Greater Gulf region are scarce. Therefore, this study will give us real-world insights into disease characteristics and various management approaches of patients with MM in the Greater Gulf region. DERR1-10.2196/49861.

Patients with myasthenia gravis (MG) undergoing immunomodulating therapies are at an increased risk of serious infections. However, the risk of developing self-limited infections, particularly upper respiratory tract infections (URTI), remains unclear. This study aimed to determine the frequency of URTI among patients with MG compared to the general population and to identify potential predisposing factors. A monthly questionnaire was administered to patients with MG and a control group over a period of 6 months. The questionnaire assessed the presence of URTI symptoms within the previous month. Statistical analysis was conducted using a chi-square or Fischer exact test, as appropriate. The study included 161 participants (50 MG patients and 111 control subjects). The frequency of URTI was comparable between the MG group (70 %) and controls (82 %) (p = 0.09). Among patients with MG, a higher proportion of patients who received rituximab developed URTI (93 %) than those who did not (61 %), P = 0.04. The frequency of URTI was similar in patients with MG compared to the general population. Due to the small sample size and several other limitations, further research is warranted to validate these findings and explore associations between rituximab and URTI. •The frequency of URTIs is similar between patients with MG and the general population.•Rituximab use increases susceptibility to URTIs in patients with MG.

This research assesses the bioenergy potential of date palm branch (DPB) waste, aligning with Saudi Arabia's Vision 2030 energy and environmental goals. The study uses reaction modeling, thermokinetics, a k-nearest neighbors (KNN) machine learning approach, and techno-economic assessments. Experimental characterizations employing FTIR, SEM, and both proximate and ultimate analysis of pulverized DPB biomass reveal its lignocellulosic nature and compositional characteristics. Thermogravimetric analysis (TGA) of the material, tested between 25 and 1000 °C at heating rates of 7.5 to 60 °C per minute, revealed that the main thermal breakdown occurred from 200 to 530 °C, and was caused by the decomposition of hemicellulose and cellulose. Criado master plot analysis of the material's thermal decomposition indicated the R3 contracting cylinder model was the most suitable reaction mechanism. The Jander [D3] and Ginstling-Brounshtein [D4] diffusion models were also good fits. The kinetic analysis showed that various model-free approaches, including FWO, KAS, STK, and FR, yielded comparable activation energy values for the hemicellulose and cellulose components, with the results clustering between approximately 98.43 and 109.30 kJ/mol. The application of the KNN machine learning technique in this study yielded accurate predictions (R2~0.975) of the TGA traces following rigorous modeling that involved hyperparameter optimization and testing of the trained model on 20% unseen data. Through a global sensitivity analysis, the degradation temperature for DPB's thermal devolatilization was identified as the key parameter controlling the pyrolysis process. The techno-economic assessments of the pyrolysis operation indicate that it is a viable, financially rewarding, and environmentally friendly process, offering valuable insights for policymakers, environmental engineers, and energy professionals toward promoting sustainable waste management and a circular economy.

Considerable research has been conducted on evaluating environmentally friendly products and consumer behavior. However, there is a paucity of substantial research investigating consumers’ environmental consciousness to predict their attitudes toward environmental concerns and green purchasing behavior. Therefore, we investigate the interrelationship between environmental consciousness and green purchasing behavior, examining how environmental concern mediates this relationship and how personality traits moderate it. The researchers used a cross-sectional research design. We employed a survey method to collect data from a sample of 351 consumers of energy-efficient electronic products in Pakistan. The PLS-SEM technique was employed for data analysis. The results showed that environmental consciousness has a significant impact on green purchasing behavior. The mediation effects of environmental concerns and the moderation effects of personality traits were also statistically significant. Within the framework of the VAB model, this study represents an early endeavor to clarify the effect of environmental consciousness on green purchasing behavior, taking into account the mediating effect of consumers’ environmental concerns. The implications of the research are discussed. Our study validated the VAB model in the domain of green consumer behavior.

Cesarean section (CS) is a surgical procedure that often saves the lives of both the mother and the baby, while a previous CS is one of the main indications for cesarean delivery in current pregnancy. Our aim was to determine the surgical and obstetrical outcomes and complication for the mother and the neonate after 4 or more CSs and compare it with mothers who had less than 4 previous CSs. This case-control study was conducted by reviewing the records of all women who underwent multiple CSs from 2013 to 2018. Our study group comprised of 394 women who had 4 or more CSs, and our control group comprised of similar number of women who had previous history of two or three CSs. A total of 788 patients were enrolled in our study. We found that adhesions were the most common complications in our study group with a considerable increase in number of both moderate and severe adhesions in the study group compared to the controls with p-value of <0.001. Increasing number of CSs leads to an increase of the complications risk. Among the complications, adhesions were the most common in our study group, followed by intraoperative bleeding.

Objectives The aim of this study was to identify the risk factors associated with nonsyndromic orofacial clefts (NSOFCs) among Saudi children. Materials and Methods A case–control study was carried out at the Ministry of National Guard Health Affairs. Cases were children with NSOFCs who were matched by gender and year of birth to healthy controls from the same setting. Data on risk factors were collected by interviewing parents of both cases and controls using a validated questionnaire. The questionnaire consisted of the father's and mother's information and the child's information. The level of significance was set at 0.05. Odds ratio (OR) and 95% confidence intervals (CIs) were used to determine the associated risk factors with NSOFCs. Results A total of 188 children were included (88 cases and 100 controls), with a mean age of 5.1 ± 2.3 years. Maternal fever during pregnancy was associated with a significantly higher risk of NSOFCs (OR = 3.4, 95% CI: 0.05–2.5, p < 0.05). Additionally, the presence of maternal relatives with orofacial clefts increased the risk (OR = 6.02, 95% CI: 0.43–3.16, p < 0.001), whereas the strongest predictor was paternal relatives with orofacial clefts (OR = 8.00, 95% CI: 0.41–3.75, p = 0.014). These findings are of utmost importance for the understanding and potential prevention of NSOFCs. Conclusions The presence of paternal or maternal relatives with orofacial clefts and maternal fever during the first trimester were predictors for NSOFCs, with having affected paternal relatives being the strongest predictor.

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

Background Intraoperative bleeding and postoperative periorbital ecchymosis are common concerns in rhinoplasty, often leading to delayed post-operative recovery. This meta-analysis aimed to evaluate the effectiveness of injectable agents in controlling intraoperative bleeding and preventing ecchymosis. Methods A systematic search of randomized controlled trials (RCTs) was conducted across multiple databases, including Cochrane, MEDLINE, and EMBASE, following the PRISMA guidelines. Studies evaluating injectables for minimizing intraoperative bleeding and postoperative ecchymosis in rhinoplasty were included. Results A meta-analysis of 6 Randomized controlled trials including 514 patients undergoing surgical rhinoplasty under 4 different interventions aimed to control intraoperative bleeding. However, Tranexamic acid (TXA) demonstrated significant superiority in reducing intraoperative bleeding compared to adrenaline 14.70 [3.05; 26.36], and control 13.85 [7.54; 20.16]. Conclusions The meta-analysis confirmed that TXA is the most effective injectable agent for controlling intraoperative bleeding and reducing postoperative ecchymosis in rhinoplasty patients. This finding highlights the importance of incorporating TXA in rhinoplasty procedures to improve surgical outcomes and patient recovery. Level of Evidence: Level I, therapeutic study.

Background Because of the use of invasive devices and procedures in critically sick patients, patients in the pediatric intensive care unit (PICU) are particularly vulnerable to nosocomial infections. Although a significant illness may necessitate admission to the PICU, infections can also emerge after admission. Nosocomial infection is a major public health issue related to increased morbidity, death, and healthcare costs. This study aimed to determine the pattern, frequency, and outcomes of nosocomial infections among children who were admitted to the PICU. Methodology This retrospective, cross-sectional study was conducted in the pediatric population aged from one month to 14 years old who acquired infections after 48 hours of admission to the PICU at East Jeddah General Hospital, Saudi Arabia from 2021 to 2022. The data were collected from medical and laboratory records. Results A total of 51 patients developed 145 nosocomial infections. Central line-associated bloodstream infections (CLABSIs) were the most commonly reported type of nosocomial infections (28.3%). The majority of the isolated organisms (58.7%) were gram-negative, followed by fungal infections (35.1%) and gram-positive organisms (6.2%). The death rate for patients with nosocomial infections was 29.4%. Increased death rates among individuals with CLABSIs and gram-negative isolates were observed to be significantly correlated (p = 0.001). Conclusions Our findings suggest that regular surveillance systems were necessary to assess the relationship between these well-known risk variables with PICU, implying that preventing these infections through particular treatments could be cost-effective and contribute to the safety of healthcare systems.Background Because of the use of invasive devices and procedures in critically sick patients, patients in the pediatric intensive care unit (PICU) are particularly vulnerable to nosocomial infections. Although a significant illness may necessitate admission to the PICU, infections can also emerge after admission. Nosocomial infection is a major public health issue related to increased morbidity, death, and healthcare costs. This study aimed to determine the pattern, frequency, and outcomes of nosocomial infections among children who were admitted to the PICU. Methodology This retrospective, cross-sectional study was conducted in the pediatric population aged from one month to 14 years old who acquired infections after 48 hours of admission to the PICU at East Jeddah General Hospital, Saudi Arabia from 2021 to 2022. The data were collected from medical and laboratory records. Results A total of 51 patients developed 145 nosocomial infections. Central line-associated bloodstream infections (CLABSIs) were the most commonly reported type of nosocomial infections (28.3%). The majority of the isolated organisms (58.7%) were gram-negative, followed by fungal infections (35.1%) and gram-positive organisms (6.2%). The death rate for patients with nosocomial infections was 29.4%. Increased death rates among individuals with CLABSIs and gram-negative isolates were observed to be significantly correlated (p = 0.001). Conclusions Our findings suggest that regular surveillance systems were necessary to assess the relationship between these well-known risk variables with PICU, implying that preventing these infections through particular treatments could be cost-effective and contribute to the safety of healthcare systems.

Limb length discrepancies (LLDs) can be treated with limb lengthening using external fixation or intramedullary nails, such as PRECICE or FITBONE. PRECICE is a magnetically driven titanium nail, while FITBONE is a motorized nail; both use an external remote control. This study aimed to determine the complications, compensation of length difference, time needed for compensation, and healing outcome of bone lengthening using motorized or magnet-driven intramedullary nails among non-cosmetic limb lengthening cases.  This retrospective study was derived from a single surgeon's practice at a tertiary hospital in Jeddah, Saudi Arabia. Between 2009 and 2020, 15 patients with LLDs, with a mean age of 25.43 years (range 16-35 years), were identified. The study included congenital, post-traumatic, idiopathic, and acquired causes of LLDs. Outcomes were measured using complete lengthening and healing indices, which need the presence of three intact cortices out of four. All patients achieved correction of their limb length without any device failure or nail breakage. The achieved limb length for all patients averaged 38.4 mm, ranging from 21 to 60 mm. No intraoperative complications were observed. Postoperatively, one patient reported knee stiffness, and another developed deep venous thrombosis. Duration of distraction (average 43.93 days, range 30-66 days) and the mean healing index was 32 days/cm for both the femur and tibia.  This study confirms that intramedullary nail PRECICE 2 and FITBONE systems are reliable and effective lengthening devices for treating lower LLDs and deformities. These devices significantly reduce complications and achieve excellent outcomes.