Digital Commons Network^™

Awareness Of The Mediterranean Diet And Its Perceived Effect On Cardiovascular Health In The Western Region, Saudi Arabia, Abdullah M. Alharbi, Mohammed S. Alsaedi, Mutaz S. Alharbi, Faisal F. Almutairi, Adeeb M. Aloufi, Azzam M. Alharbi, Rakan D. Alsaedi, Hatim F. Alhejaili, Motasem M. Alyamani

Saudi Medical Journal

Objective: To increase awareness of mediterranean diet (MD) and its perceived effects on cardiovascular health, enhance knowledge and inform public health efforts aimed at improving the population's health outcomes of. The MD comprises heart-healthy eating patterns high in vegetables, legumes, nuts and seeds, and fruits. Methods: This cross-sectional study involved adult participants who were living in the Western region of the Kingdom of Saudi Arabia. The data were collected online through social media platforms, then cleaned, coded, and analyzed using Statistical Package for the Social Sciences, version 21 to generate key insights. Results: A total of 390 participants were included …

Early Initiation And Dual Patterns Of Cigarette And E-Cigarette Use Among Adults In The Eastern Province, Saudi Arabia: A Cross-Sectional Study, Haidar A. Alridha, Nora A. Alafif

Saudi Medical Journal

Objectives: To explore the early initiation of cigarette and e-cigarette use and the dual patterns of usage among adults in the Eastern Province of Saudi Arabia. Methods: A cross-sectional survey was conducted from December 2024 to February 2025 among adults living in the Eastern Province. An online self-administered questionnaire collected data on sociodemographic characteristics, smoking behaviors, age of initiation, dual-use patterns, and quit attempts. Convenience sampling was applied, and a total of 551 participants were included. Descriptive statistics summarized distributions of smoking behavior and initiation age. Pearson's Chi-square tests were used to examine associations between smoking status, age of initiation, …

Multidimensional Predictors Of Disease Severity And Health Outcomes In Patients With Sickle Cell Disease: A Data-Driven Clinical Insight, Hind A. Alzahrani, Ruba Omar Mohammed Almaghrabi, Raed Alharbi, Abdulaziz Saleh Alghamdi, Mohammad A. Albanghali, Hanan E. Alyahyawi, Abdulmohsen M. Alruwetei, Besma Garah, Mohammed Alzahrani, Samar Hassan Hjar, Sana Shaker

Saudi Medical Journal

Objectives: To describe the clinical, hematologic, and therapeutic characteristics of hospitalized adults with sickle cell disease (SCD) in the Al-Baha region and to identify factors that predict hospitalization as well as transfusion frequency. Methods: A retrospective observational analysis was conducted on 117 adults with confirmed SCD who were admitted to King Fahad Hospital-Al-Baha during 2022–2024. Demographic information, hematologic parameters, clinical features, hospitalization rate, transfusion history, and treatment protocols were collected from the electronic medical records. Statistical analyses (ANOVA, Kruskal-Wallis test, Chi-square tests, and Fisher's exact Test) were performed to compare between groups where applicable. Results: The cohort had a mean …

Prevalence And Clinical Correlates Of Intraspinal And Vertebral Anomalies In Congenital, Adolescent Idiopathic, And New-Onset Scoliosis: A Comparative Study In Saudi Arabia, Faisal M Alkhunein, Mishari N Alanezi, Nwaf A Alshahir, Abdulkarim S Alsulimi, Abdulrahman H Salman, Habib Ullah Chaudhary, Abdulmajeed A Alzakri

Saudi Medical Journal

Objective: To explore the prevalence of and clinical associations between intraspinal and vertebral abnormalities in patients with congenital scoliosis (CS), adolescent idiopathic scoliosis (AIS), and early-onset scoliosis in Saudi Arabia. Methods: This retrospective cohort investigation included patients aged 18 years or younger diagnosed with CS, AIS, or new-onset idiopathic scoliosis who underwent full-spine magnetic resonance imaging between 2015 and 2025 at a tertiary center in Riyadh, Saudi Arabia. Clinical and radiological data were collected, and intraspinal and vertebral anomalies were classified. Statistical analyses included Chi-square, Fisher's exact test, and the Wilcoxon rank-sum test, with significance set at p < 0.05. Results: A …

Dietary Fat Intake And Its Influence On The Association Between Liver Fat And Brain Choline Metabolism In Young Saudi Women, Halima S. Hawesa, Mansour E. Shanawani, Haya A. Alshegri, Mahasin G. Hassan, Amal I. Alorainy, Nouf A. Alroqaiba, Shanoo G. A. Sheikh

Saudi Medical Journal

Objective: Fat-rich nutrition may influence the neurochemical consequences of hepatic lipid accumulation. This study examined whether percent energy from fat modifies the association between liver fat and the brain (Cho/Cr) ratio in healthy young women. Methods: A total of 109 healthy Saudi women aged 18–25 years underwent brain magnetic resonance spectroscopy (¹H-MRS) to quantify Cho/Cr ratios. Liver fat was estimated using MRI-based proton density fat fraction (PDFF), and lipid intake was assessed using a validated food frequency questionnaire. Multivariable regression models tested the interaction between liver fat and fat-derived energy intake, followed by simple slopes analysis, regression …

Urinary Incontinence's Prevalence, Risk Factors, And Quality Of Life Impact On Working Women In Saudi Arabia, Ahmed Mansor, Hatim Tagalsir Osman Ali, Maha Ali, Arwa Abd Al Salam Ashry, Ghala Abdullah Alharbi, Khalid Albasheer, Omer Munder, Isam Mohamed Babbiker Ahmed

Saudi Medical Journal

Background: This study aimed to investigate the prevalence and severity of Urinary incontinence (UI) among working women in Saudi Arabia (SA), identify the associated demographic, lifestyle, medical, and obstetric risk factors, and assess its effect on quality of life and work productivity. The UI is a common underreported condition that affects women's daily functioning and life quality, particularly in the workplace. Methods: During 2025, 390 working women in SA who were at least 18 years old and from various work sectors participated in a descriptive cross-sectional survey. Data were gathered using a validated, structured questionnaire; statistical analysis was carried out …

Artificial Intelligence In Pharmaceutical Care: Transforming Drug Discovery, Development, And Patient-Care Delivery, Abdulrahman G. Alharbi, Abdulrahman A. Aljabri

Saudi Medical Journal

The integration of artificial intelligence (AI) into pharmaceutical care represents a paradigm shift in healthcare delivery, offering unprecedented opportunities to revolutionize medication management, accelerate drug development, and enhance patient outcomes. This comprehensive review synthesized evidence from global literature (2021–2025) examining AI applications across drug discovery and development, clinical trials optimization, medication therapy management, and pharmacy operations. The AI demonstrated prediction accuracies of 86–98% in drug discovery, 80% improvement in clinical trial recruitment efficiency, and 32.7% increase in medication adherence over standard care. The global AI drug discovery market, valued at \$1.5 billion (2023), is projected to reach \$11.8 billion by …

Emerging Strategies For Cardio-Renal Protection Beyond Raas Blockade: Emphasis On Non-Diabetic Ckd And Resistant Hypertension, Fahad S. Alrashidi

Saudi Medical Journal

Non-diabetic chronic kidney disease (ND-CKD) complicated by resistant hypertension remains a high-risk phenotype even when renin–angiotensin system blockade is optimized. This review synthesizes contemporary evidence for cardio-renal protection beyond traditional renin-angiotensin-aldosterone system inhibition (RAASi), with emphasis on mechanisms, clinical trial data, and pragmatic sequencing. Sodium–glucose cotransporter 2 inhibitors provide hemodynamic and tubular benefits that translate into renal and heart failure risk reduction in many patients with ND-CKD. Non-steroidal mineralocorticoid receptor antagonism (MRA) like finerenone targets inflammatory and fibrotic signaling and may add incremental benefit when potassium is proactively managed. The GLP-1 receptor agonists offer cardiometabolic advantages with emerging kidney signals, …

The Use Of Platelet-Rich Plasma For De Quervain's Tenosynovitis: A Systematic Review With Limited Meta-Analysis, Abdullah W. Abumadian, Mohanad I. Binibrahim, Abdurrahman H. Sultan, Mohammed A. Addas, Hattan Y. Bamagaus, Sultan K. Alhaddad, Motasem O. Bamabad, Bayan A. Ghalimah

Saudi Medical Journal

Introduction: De Quervain's tenosynovitis (DQT) is a painful wrist condition that impairs daily activities. Corticosteroid (CS) injections are commonly used for symptom relief, but their effects may diminish over time. Platelet-rich plasma (PRP) has emerged as a regenerative alternative that promotes tissue healing rather than merely suppressing inflammation. This systematic review and limited meta-analysis compare the efficacy and safety of PRP versus CS injections in DQT. A limited meta-analysis was chosen due to the high heterogeneity between studies (I² = 98.7%). Methodology: A comprehensive literature search identified six studies comparing PRP and CS injections. Pain and functional outcomes …

Healthcare-Associated Infection Causes And Mitigation Strategies: A Systematic Review, Mohammad Irfan, Nahed Alquwez

Saudi Medical Journal

Objective: To describe the landscape of healthcare-associated infections (HAI) and, in particular, to pay attention to the types of infection that are usually seen, the most common infectious agents involved and the effective prevention strategies. Methods: A detailed search was performed using Google and PubMed, and studies that exclusively addressed healthcare associated infections or their mitigation. Studies published since 2000 were included. Data from individual articles were extracted and categorized by study focus, type of infection, causes and contributing factors, and documented mitigation strategies. Editorials, reviews, case studies, meta-analyses, and systematic reviews were excluded. Results: The analysis showed that infections …

Clinical Outcomes Of Decompression Versus Decompression With Instrumented Fusion For Lumbar Spinal Stenosis Secondary To Degenerative Spondylolisthesis: A Systematic Review And Meta-Analysis, Lama N. Alqahtani, Ahmed K. Alzahrani, Razan A. Almutairi, Abdulaziz M. Salah, Shahad F. Khan, Mohammad G. Sindi, Khalid E. Fassi, Abdulrahman M. Alshami, Ibrahim A. Hakami

Saudi Medical Journal

Objective: To compare decompression alone with decompression with fusion in patients with degenerative lumbar spondylolisthesis. Methods: PubMed, Google Scholar, Ovid, and Web of Science databases were searched up to March 2025 for randomized controlled trials (RCTs). The primary outcomes were the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. The secondary outcomes included operative time, length of hospital stay, intraoperative blood loss, reoperation, complications, and cost. Pooled analysis was performed using a random-effects model in Review Manager following Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. The quality of included randomized trials was evaluated using the …

Dual-Pathway System For Low-Latency Pii Redaction In Generative Image Modification, Mira Leung

Defensive Publications Series

Some personally identifiable information (PII) redaction methods for generative image applications can have high latency and computational costs, which may limit their use in interactive contexts. A dual-pathway architecture may be used to process image modification requests. A synchronous, low-latency pathway can detect and obfuscate potential PII before a generative model concurrently inpaints the obfuscated areas and applies user modifications. Simultaneously, an asynchronous, offline pathway can generate a more thoroughly redacted version of the source image and store it for future use. This hybrid approach can provide a low-latency response suitable for on-demand image generation, while progressively creating higher-quality redacted …

Generating Synthetic User Populations Via World Simulation For Privacy-Safe Ai Evaluation, Amey Venkatanarayan, Yen-Ting Liu, Kamakshi Kodur, Paddy Flynn, Yue Hu, Jose Jimenez-Olivas, Zhewen Song

Defensive Publications Series

Evaluating personalized artificial intelligence (AI) systems may be challenging, as the use of detailed user context can conflict with user privacy considerations. A system is described for generating synthetic user populations via a world simulation. The system can create generative agents with demographic and behavioral characteristics based on aggregated, anonymized statistical data. These agents can interact over time within a simulated environment, producing a stream of longitudinal user behavior captured in isolated test accounts. The resulting dataset can be used for scalable, automated testing and debugging of AI models, offering a contextually rich, privacy-respecting alternative to using real user data. …

Agent-Aware Mesh Network For Hybrid Ai Policy Enforcement, Antonio Ojea

Defensive Publications Series

Organizations in regulated sectors may face challenges using large-scale, cloud-based artificial intelligence (AI) services because of data sovereignty and compliance mandates. A system may provide a decentralized, agent-aware mesh network that functions as an infrastructure layer to bridge on-premise environments and external AI services. This network can intercept and semantically understand complex agent communications, allowing an active enforcement layer to perform actions such as sanitizing data, pausing high-risk operations for human review, and maintaining a sovereign audit log. This approach can allow organizations to leverage advanced AI reasoning capabilities from external providers while assisting in the maintenance of local control …

Reverse Hook Tent Peg Longer Diagonal, John Riley Mr

Defensive Publications Series

A reverse hook tent peg which redirects forces (as opposed to a traditional tent peg) and increases its holding power in the ground. The horizontal section flexes in windy conditions and retains its shape better than a traditional peg thus maintaining guy line tension more effectively. This version has a longer diagonal in proportion to the horizontal than in previous submissions. No claim is made on colour.

Phosphosulindac And Other Compounds, Anonymous

Defensive Publications Series

Disclosed are compounds expected to share properties of phosphosulindac.

The Role Of The Nlrp3 Inflammasome In Preeclampsia And Implantation Failure: A Molecular Review, Ari Budi Suryawinata, Mariel Tania Darmayani, Listyani Suhargo

Chulalongkorn Medical Journal

The NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome is a critical multiprotein complex of the innate immune system that functions as a molecular sensor for a wide array of danger signals. While its activation is essential for host defense and tissue homeostasis, its dysregulation is increasingly implicated in the pathophysiology of numerous inflammatory disorders. This review article synthesizes the current molecular understanding of the NLRP3 inflammasome, focusing on its dual role in health and disease. We first provide a concise overview of the canonical two-step mechanism of NLRP3 activation and the intricate molecular checkpoints including genetic factors, post-translational …

Effects Of Maternal Vitamin D Supplementation During Pregnancy And Lactation On Immune Development In Offspring: A Systematic Review, Kurnia Maidarmi Handayani, Ghaniyyatul Khudri, Laura Zeffira, Widia Sari

Chulalongkorn Medical Journal

Background: Vitamin D, a fat-soluble prohormone, is essential for skeletal health and plays a key role in immune regulation. Deficiency is common among pregnant and lactating women, raising concerns as fetal and neonatal vitamin D status relies entirely on maternal stores. Insufficiency during these periods is linked to preterm birth, low birth weight, and immune-mediated disorders. This review examines the effects of maternal vitamin D supplementation on the immune development of offspring.

Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251117397). Experimental rodent studies published between 2019 and 2022 that investigated maternal vitamin …

Skip Segment Hirschsprung's Disease: Report Of A Rare Case And Literature Review, Nimmita Srisan, Paisarn Vejchapipat, Natcha Wanpiyarat

Chulalongkorn Medical Journal

We present an unusual case of skip segment Hirschsprung’s disease which was initially diagnosed with total colonic aganglionosis. A term male newborn presented with distal intestinal obstruction underwent exploratory laparotomy at three days old after ultrasound-guided contrast enema. Intra-operative frozen section of the full-thickness biopsies of each part of the colon and terminal ileum reported no ganglion cells, so we performed double-end ileostomy. Although all the final pathology reports confirmed no ganglion cells similar to the frozen sections, we were curious about the problematic bowel because of preoperative imaging (at the age of 30 months) which showed dilated transverse colon. …

Pituitary Apoplexy In A 19-Year-Old Woman: An Uncommon Age And Gender Presentation, I Ketut Aryawan, Jovita Jutamulia

Chulalongkorn Medical Journal

Pituitary apoplexy is a rare clinical syndrome caused by acute hemorrhage or infarction of the pituitary gland. It is most frequently reported in men during the 5th and 6th decades of life and is rarely encountered in young women. We describe a 19-year-old woman who presented with acute visual disturbance accompanied by occasional mild headache. Ophthalmologic examination revealed bitemporal hemianopia, and head MRI demonstrated an intrasellar mass with suprasellar extension, intratumoral hemorrhage, and optic chiasm compression, consistent with pituitary macroadenoma with apoplexy. The patient also had a history of secondary amenorrhea, suggesting possible endocrine dysfunction. This case highlights the importance …

Association Between Underpants Fit And Semen Quality: A Hospital-Based Cross-Sectional Study, Harnam Kaur, Unnop Jaisamrarn, Paweena Thuwanut, Chanakarn Suebthawinkul, Jiayu Li

Chulalongkorn Medical Journal

Background: The effect of underpants type on semen parameters remains controversial. Conducting such a study in the Thai population will contribute valuable region-specific data.

Objectives: This cross-sectional research studied the influence of fit of underpants worn on various semen parameters including semen volume, sperm count, sperm motility, sperm morphology and sperm DNA fragmentation among Thai male partners in Bangkok, Thailand.

Methods: Thai male partners aged 20–55 years who sought infertility treatment from Reproductive Biology Unit, King Chulalongkorn Memorial Hospital, Bangkok were recruited from March to June 2024. All participants completed questionnaire covering socio-demographics, disease history, and type of underpants worn …

Effectiveness And Implementation Of The Shield Integrated Multi-Level Model To Reduce Adolescent Depression And Internet Addiction: A Cluster Randomized Waitlist-Controlled Trial In Wangchin District, Phrae Province, Seubtrakul Tantalanukul, Amornpan Samorn

Chulalongkorn Medical Journal

Background: Adolescent depression and internet addiction represent significant comorbid mental health challenges in rural Thailand, where access to evidence-based interventions remains limited. Traditional single-modality approaches often fail to address the complex interplay between individual, family, and systemic factors contributing to these conditions.

Objectives: To evaluate the effectiveness and implementation outcomes of the SHIELD (Screening & Surveillance, Health Literacy Enhancement, Internet Wellness Program, Empowering Families, Linkage to Care, Data-driven Monitoring) integrated multi-level intervention for reducing depression and internet addiction among at-risk adolescents in rural Thailand.

Methods: A cluster randomized waitlist-controlled trial was conducted across eight secondary schools in Wangchin District, Phrae …

Computed Tomography Findings Of Normal Appendix In Pediatric Population, Thanwarat Koonthong, Teerasak Phewplung*

Chulalongkorn Medical Journal

Background: Appendicitis remains the most common indication for emergency abdominal surgery in children. Computed tomography (CT) plays a vital role in the evaluation of pediatric patients with suspected appendicitis. Yet, there is limited of literature describing the normal appendiceal diameter in the pediatric Asian population.

Objectives: To characterize the normal pediatric appendix and to identify the variables that influence its diameter in pediatric patients aged one day to 18 years who underwent abdominal CT.

Materials and Methods: The study was approved by the IRB. We conducted a retrospective study of 358 children (≤18 years of age) who underwent abdominal CT …

Global Trends In School Disaster Preparedness Research: Bibliometric Analysis Impacts On Public Health And Safety, Muhammad Farid, Muhammad Agita Hutomo, Oktomi Wijaya, Dian Ika Puspitasari

Chulalongkorn Medical Journal

Background: Disasters disrupt daily human activities, arising from natural or artificial triggers, with varying impacts based on community vulnerability and resource capacity. Effective disaster management involves a cycle of mitigation, preparedness, response, and recovery. One of the mitigation measures is to establish school disaster preparedness that integrate education and capacity building.

Objective: The aim of this research is to conduct a bibliometric analysis based on Scopus publications regarding school disaster preparedness.

Methods: A bibliometric analysis was performed on publications indexed in Scopus from 1965 to 2024. Data were processed and visualized using VOSviewer to explore trends in annual outputs, contributing …

Analysis Of Quasi-Periodic Waves Of Cubic Nonlinear Schrödinger Equations, Perla Kfoury, Stefan Le Coz, Tai-Peng Tsai

University of Tennessee Mathematical Journal

We study the quasi-periodic standing wave solutions of the focusing and defocusing cubic nonlinear Schrödinger equations in dimension one. In the defocusing case, we establish  a diffeomorphic correspondence between the invariants of the ordinary differential equation of the wave profiles and the conserved quantities of the evolution equation. We introduce a numerical scheme to compute the minimizers of the energy at fixed mass and momentum for both focusing and defocusing cases. The scheme is based on a gradient flow approach with discrete renormalization at each time step.  The novelty of our scheme is that the renormalization step deals at the …

Empowering Tomorrow’S Eco-Leaders: The Role Of Student-Led Recycling And Energy Conservation Initiatives In Fostering Environmental Sustainability In Educational Institutions, Angel Christian S. Arisga, Constantino G. Medilo Jr.

Journal of Educational Research and Practice

Environmental sustainability is now a growing priority in educational institutions as global environmental challenges continue to intensify. This paper studies the role of student-led recycling and energy conservation initiatives in promoting eco-friendly practices and developing environmental accountability among learners. Drawing on existing literature, the study illustrates how active student participation in waste management programs, recycling campaigns, renewable energy implementation, and energy audits contributes to reduced waste generation, lower energy consumption, and decreased greenhouse gas emissions in school settings. Apart from environmental outcomes, these projects foster essential competencies such as leadership, collaboration, problem-solving, and environmental awareness, positioning students as agents of …

Bridging The Gap Between Research And Practice In Schools, Giorgio Ostinelli

Journal of Educational Research and Practice

This case study examined how a group of Swiss primary school teachers collaborated with a school improvement advisor/researcher (SIA); it is now part of a larger project that uses a design-based methodology. The SIA is a rising entity in the educational landscape and serves as a state-mandated coach who bridges the gap between universities and schools. The SIA embodies the characteristics of both an educational researcher and a school advisor/coach. The SIA experience was created and designed using a frame–object, a valuable tool for collaboratively building professional development experiences with teachers and coaches. Understanding by Design served as the frame–object …

Leading Through Difference: Core Values, Neuroscience, And The Habits Of Transformative Leaders, Jaime E. Welborn

The Journal of Values-Based Leadership

Educational leaders are increasingly called to meet the demands of K-12 schools by managing diversity, navigating conflict, and leading change. One's core values, neuroscience, and cultural proficiency of educational practices play a very important role in how they lead organizations and interact with others. This conceptual paper explores the intersection of neuroscience, core values, and associated habits that support effective cross-cultural interactions. Drawing upon frequency count data from documents collected during professional learning activities in school organizations in New York, Missouri, and California from 2018 to 2025, empathy, open-mindedness, and communication emerged as the most frequently reported important core values …

Francis Bacon As Philosopher Of Leadership: The Essays As Manual For Values-Based Leaders, Matthew Sharpe

The Journal of Values-Based Leadership

This essay presents the case for Francis Bacon as what we would today term a leadership theorist avant la letter, focusing on the development of the character of leaders, faced with all the pressures of their role.  We aim to show Bacon's leadership theory at once anticipates without directly embodying contemporary leadership theories (in part 1): not only presenting a robust moral vision for leadership, as serving the public good (part 2), but differentiating characteristic kinds of “followers,” with their strengths, weaknesses, and characteristic vices, and realistically addressing how to best lead them (Part 3); and providing ten "how …

Learning Values-Based Leadership Through Practice, Jenny Guan

The Journal of Values-Based Leadership

This essay explores how values-based leadership can be developed through leadership practice in real-world contexts. Drawing on a Servant Leadership book project involving global contributors, it adopts the Values Clarity Model™ as a reflective lens and uses a practice-based approach informed by observation, imitation, and reflection to examine how leadership values are enacted in authentic settings. By analyzing the project in relation to what I learned in the Principles of Business Leadership course at business school, this essay reflects on how leadership values are understood, practiced, and internalized in real-world settings.

This reflection suggests that values-based leadership is not formed …