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Erratum To ``Unmasking Iron Deficiency And Iron Deficiency Anemia In Saudi Arabia'' [Saudi Medical Journal 2025; 46(9):1000–1007], Osman O. Radhwi, Omar M. Raslan, Eman M. Mansory

Saudi Medical Journal

In the manuscript entitled ``Unmasking Iron Deficiency and Iron Deficiency Anemia in Saudi Arabia,'' published in Saudi Med J 2025; Vol. 46(9):1000–1007. doi: 10.15537/smj.2025.46.9.20240970.
The correct affiliation should read as follows: Department of Basic Science, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia.

Advancing Rheumatology In The Middle East: Mrc 2025 Abstracts, Martin Lee, Ahmed Zayat, Beena Hameed, Elsadeg Sharif, Fahda Al Okaily, Fehaid Alanazi, Francis Kynaston-Pearson, Khalid A. Alnaqbi, Mahmood Hachim, Mayam Al Nesf, Mira Mirashli, Mohammed Tariq, Ravi Gutta, Reem Abdwani, Saadeya Naji, Shamma Lootah, Tareq Al Araimi, Waleed Hafiz, Suad Hannawi

Saudi Medical Journal

No abstract provided.

Middle East Bifurcation Club Consensus Document On Percutaneous Revascularization Of Bifurcation Lesions In Association With The National Heart Center – Saudi Health Council, Khaled Al-Shaibi, Mirvat Alasnag, Haitham Amin, Ali Nazmi Calik, Ali Almasood, Abdullah Alenezi, Nouf Alanazi, Abdulrahman Almoghairi, Hadi Abu-Hantash, Khaled Almerri

Saudi Medical Journal

Bifurcation lesions are among the most challenging in percutaneous coronary intervention (PCI), with outcomes affected by anatomy, side-branch disease, and procedural variability. Existing European definitions and strategies require adaptation for Middle Eastern populations, where diabetes, obesity, and hypertension are highly prevalent and present earlier. The Middle East Bifurcation Club (MEBC), with the National Heart Center, used the Nominal Group Technique to standardize bifurcation PCI terminology, techniques, and treatment pathways tailored to regional demographics. The consensus provides evidence-based recommendations on imaging, provisional and 2-stent strategies, POT, and left main versus non-left main bifurcations, alongside practical algorithms and heart team guidance, highlighting …

Rethinking Health-Care Efficiency: A Call For A Multi-Dimensional Framework For Assessing Healthcare System Efficiency, Yasser K. Alotaibi, Ali N. Alharbi

Saudi Medical Journal

No abstract provided.

Prevalence Of Brca1 And Brca2 Germline Mutations In Western Saudi Patients With Epithelial Tubo-Ovarian Carcinoma, Wala Mehros, Faisal Aldaheri, Anas Alqarni, Saif Aljehani, Abdulrahman Alnamlah, Alaa Althubaiti, Safaa Huneef, Hatim Jifree

Saudi Medical Journal

Objective: Ovarian cancer represents the most lethal gynecologic malignancy, the epithelial type (EOC) being the most common. BRCA gene mutations are associated with ovarian cancer, younger age at presentation, strong family history of EOC, and multiple malignancies in a single patient. This study calculated the rate of BRCA-positive EOC and compared BRCA-mutated vs non-mutated EOC cases. Methods: This retrospective cohort study, conducted at Princess Noura Oncology Center between May 2016 and December 2023, explored outcomes in BRCA-positive EOC patients. The inclusion criteria covered all EOC cases. A total of 70 patients were selected. Results: Of the 70 …

The Nephroprotective Effects Of Dulaglutide In Patients With Type 2 Diabetes And Chronic Kidney Disease: A Multicenter Saudi Arabian Study, Maha H. Jamal, Hassan A. Alzahrani, Duaa M. Bakhshwin, Ranya A. Ghamri, Fatmah S. Binzomah, Wisam H. Jamal, Moaz W. Abulfaraj

Saudi Medical Journal

Objective: This study aimed to evaluate the effectiveness and safety of dulaglutide in individuals with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Methods: This retrospective cohort study included 212 patients with CKD (stages 1–4) and T2DM treated with once-weekly dulaglutide (1.5 mg) for either 12 or 24 months at three tertiary care centers in Saudi Arabia from January 2021 to December 2023. Safety was assessed based on the presence of adverse events. Efficacy was measured using the changes in estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), and body mass index (BMI). Changes in efficacy outcomes were …

Combined Predictive Value Of Serum Ngal, Cysc, Urinary Nag, And Egfr For Sepsis-Associated Acute Kidney Injury In Patients In Icu, Yu Han, Wenna Ning, Jian Lu, Jinwei Zhu, Zhiliang Qin, Xiao Wang

Saudi Medical Journal

Objective: To evaluate critically ill patients who had sepsis and how various kidney-related measurements, including eGFR, NGAL, CysC, and the urinary enzyme NAG, predict the onset of sepsis-induced renal damage. Methods: The 135 individuals who were admitted to our sepsis intensive care within 2 years to the end of early 2024 were recruited on a prospective basis and were enrolled based on the predefined criteria. Upon admission, they were dichotomized into 2 groups of participants who developed septic-associated kidney injury (82) and without (53). A comparison of baseline laboratory analyses and blood and urine baseline examinations in the groups was …

Comparison Of Clinical Outcome Of Mushroom Poisonings With And Without Specific Treatment: A 5-Year Retrospective Analysis, Kamil Deveci, Necmi Baykan, Baycan Kus, Fatma Ünlü, Ömer Salt, Serhat Koyuncu

Saudi Medical Journal

Objectives: To determine the demographic and clinical characteristics, potential specific antidote treatments, clinical outcomes, and organ failure (morbidity) rates of patients with mushroom poisoning admitted to our center. Methods: We included 425 patients admitted to the emergency department of Kayseri City Hospital complaining of mushroom poisoning, between May 2018 and December 2023, who met the study criteria. Results: The median age of the 425 patients admitted was 51 years (34–63); 49.5% were female (n = 211), and 75% (n = 319) were admitted by ambulance. According to the Poisoning Severity Score, 70.3% (n = 299) of cases were mild, 21.9% …

Ethnic Background As A Determinant Of Thyroid Cancer Risk: A Decade-Long National Cohort Study Reveals Divergent Epidemics In Saudi Arabia, Nizar A. Khamjan

Saudi Medical Journal

Objectives: To analyze and compare temporal trends, demographic characteristics, and stage at diagnosis for thyroid cancer (TC) between Saudi and non-Saudi populations in order to identify potential population-specific etiological drivers. Methods: We conducted a national retrospective cohort study of TC cases in Saudi Arabia from 2013–2022. To assess population-level trends, we computed age-standardized incidence rates (ASIRs) and multivariable Poisson regression alongside piecewise regression models for comparative analysis. Results: Among 14,159 total cases, TC incidence increased disproportionately in Saudi nationals, rising from 884 to 1,677 (90%), significantly outpacing the 184 to 275 (49%) increase observed in non-Saudis. The incidence rate ratio …

Comparison Of The Predictive Value Of Crp/Albumin, Crp/Prealbumin, And The Clinical Frailty Scale For Mortality In Geriatric Intensive Care Patients, Natali T. Aksoy, Bülent B. Güven, Sümeyya M. Soyalan, Dilek Metin Yamaç, Tuna Ertürk, Süheyla Abitağaoğlu

Saudi Medical Journal

Objectives: To evaluate the relationship between C-reactive protein (CRP)/prealbumin and CRP/albumin ratios, Clinical Frailty Scale (CFS) scores, and short-term (first 3 days) and long-term (28 days) mortality in geriatric patients hospitalized in the intensive care unit. Methods: After obtaining ethical approval and informed consent, 213 patients aged 65 years and older were included. Patients discharged within 24 hours, those discharged and readmitted during the study period, those receiving routine albumin replacement, and patients with cirrhosis or undergoing chronic dialysis were excluded. Demographic characteristics, admission diagnoses, chronic comorbidities, frailty scores at admission, and laboratory values, including albumin, prealbumin, and CRP …

Tumor-Associated Neutrophils In Advanced Non-Small Cell Lung Cancer Patients Predicted By Clinicopathologic Characteristics And Peripheral Blood Markers, Weiwei Hong, Xie Xiong, Chen Fang, Chuanhong Luo, Xiaoying Qian, Xinyuan Yao, Xin Ye, Biao Yu, Bingbiao Zhou, Dengying Chen, Chengsi Shu, Yong Wang, Yong Li

Saudi Medical Journal

Objectives: The process of analyzing tumor-associated neutrophils (TANs) types is complex. This study explored the relationships among clinicopathological characteristics, peripheral blood markers, and TANs. Methods: Clinical information was retrospective gathered for 115 patients in our hospital from May 2019 to May 2021, and multiplex immunofluorescence staining was utilized to access the expression of TANs and analyze the potential relationship between TANs and clinicopathological features or peripheral blood markers. Results: Among the 115 patients, the proportion of female patients within the neutrophils (N1)-low group was notably greater compared to the N1-high group (87.5% vs. 12.5%, p = 0.022). In nonsmoking patients, …

Clinical Role Of Hematologic Inflammatory Markers In The Diagnosis Of Missed Abortion, Mustafa Bakırcı, Çağlayan Ateş, Ethem S. Yalvaç

Saudi Medical Journal

Objectives: To evaluate the diagnostic value of hematological and biochemical inflammatory markers in distinguishing missed abortions from healthy pregnancies during the first trimester. Methods: This retrospective case-control study was conducted between May 2022 and May 2024, included 61 women diagnosed with missed abortion by ultrasound and 100 healthy pregnant women who acted as controls. The following inflammatory markers were calculated from routine blood and biochemistry results: neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation index (SII) and C-reactive protein-albumin ratio (CAR). Intergroup comparisons and receiver operating characteristic (ROC) curve analyses were performed. Results: The …

Concurrent Appendectomy In Patients Undergoing Surgery For Gynecological Malignancies: A Retrospective Analysis From A Tertiary Referral Center, Gazi Güner, Can Tercan, Emrah Dağdeviren, Ali Selçuk Yeniocak, Ceylin Elbistanli, Sure Nur Erdoğmuş, Ayşe Hazirbulan, Yiğit Mert Bayrak, Neçirvan Çağdaş Çaltek, Gözde Şahin, Ergun Tercan, Figen Efe Çamili, Nazlıaylin Vural, Hüseyin Karatay, Saniye Merve Gül Kara, İlkbal Temel Yüksel

Saudi Medical Journal

Objectives: To evaluate appendectomy specimen findings and their association with tumor type and stage. Concurrent appendectomy is frequently performed during gynecologic oncology surgery to prevent postoperative appendicitis and detect occult pathology, yet its value remains debated. Methods: In this study, we reviewed the medical records of 300 women who underwent gynecologic oncologic surgery accompanied by appendectomy at Başakşehir Çam and Sakura City Hospital (Istanbul, Türkiye) over the period from July 2020 to April 2025. Clinical, surgical, andhistopathologic data were collected. Appendiceal pathologies were categorized as reactive hyperplasia, chronic inflammation, benign neoplasms, metastatic tumors, or primary. Statistical analyses included chi-square, t-test, …

Reliability And Validity Of The Arabic Version Of The Nose-Perf Scale, Rayan M. Alfallaj, Abdullah I. Binghaith, Mohammed Y. Alyoussef, Ahmed S. Alsaleh, Saad A. Alsaleh, Abdulaziz A. Alqahtani, Ahmad S. Alroqi

Saudi Medical Journal

Objectives: To assess the psychometric validity of the Arabic adaptation of the nasal obstruction symptom evaluation–perforation (NOSE-Perf) scale. To assess how reliable and valid the Arabic adaptation of the NOSE-Perf questionnaire is. Patients with septal perforations, particularly Arabic speakers, lack validated self-assessment tools for subjective symptom evaluation. Methods: Conducted between May 2024 and June 2025, the study included 100 participants—20 patients with septal perforation and 80 controls. Participants filled out a questionnaire consisting of demographic data as well as the Arabic forms of the Sino-Nasal Outcome Test-22 (SNOT-22), NOSE, and NOSE-Perf scales. Cronbach's alpha was applied to determine internal consistency, …

A Multi-Centre Study: Quantitative Evaluation Of Radiation Dose For Adults Head Computed Tomography, Abdulaziz A. Qurashi, Shrooq T. Aldahery

Saudi Medical Journal

Objectives: To determine regional radiation dose in adults head computed tomography (CT) examinations in Jeddah by assessing the volume computed tomography dose index (CTDI_vol) and dose length product (DLP) values. Methods: A retrospective study was conducted from February to April 2025 across 10 CT scanners from 5 governmental hospitals in Jeddah. Data for 20 head CT examinations per scanner were collected. Dose metrics including CTDI_vol and DLP (mGy·cm), were extracted from digital imaging and communications in medicine (DICOM) images. Mean values per scanner and the 75^th percentile were calculated across centres to identify the regional DRL. …

The Role Of The Delta Neutrophil Index In Determining The Severity Of Intrahepatic Cholestasis Of Pregnancy, Selçuk Atalay, Melike Çaltekin, Nihal Çallıoğlu, Fırat Ersan, Verda Alpay, Yasin Anasız, Ipek Geyikoğlu

Saudi Medical Journal

Objective: This study aimed to investigate the clinical utility of the delta neutrophil index (DNI) in distinguishing patients with intrahepatic cholestasis of pregnancy (ICP) from healthy pregnant women, and to assess its potential role in evaluating disease severity. Methods: This retrospective analysis included data from 249 pregnant women. Among them, 131 were identified with ICP, based on clinical symptoms and total bile acid levels ≥ 10 μ mol/L. The remaining 118 participants served as healthy controls. The ICP cases were categorized into mild (TBA 10–39 μ mol/L; n = 90) and severe (TBA ≥ 40 μ mol/L; n = 41) …

Integrative Approaches To Gut Microbiota: Biomarkers, Dysbiosis, And Therapeutic Potential, Zeyad M. Alharbi

Saudi Medical Journal

The human gut contains bacteria, viruses, and archaea that influence health depending on age, diet, and location. An individual harbours about 150 bacterial species. An imbalance of these microorganisms, known as dysbiosis, can negatively impact health. Commensal bacteria maintain microbial homeostasis by building short chain fatty acids. The 2-way communication channel that connects the gut and the brain is referred to as the gut-brain axis. Dysbiosis of the gut leads to some autoimmune diseases. A decline of beneficial bacteria causes the progression of rheumatoid arthritis. Gut dysbiosis increases intestinal permeability, allowing toxins and cytokines to enter the bloodstream and damage …

Emerging Nanotherapy Applications In Cancer Treatment: A Comprehensive Review, Waleed H. Mahallawi

Saudi Medical Journal

This comprehensive review synthesizes recent advances in cancer nanotherapy, focusing on 6 emerging categories: immunomodulation, gene/RNA delivery, theranostics, radiosensitization, biomimetic carriers, and artificial intelligence (AI)-guided formulations. These innovative platforms demonstrate transformative potential by overcoming key limitations of conventional cancer treatments. Immunomodulatory nanoparticles reprogram tumor microenvironments and convert immunologically ``cold'' tumors to ``hot'' responsive states. Gene delivery systems enable precise editing with >50% efficiency, while theranostic platforms integrate real-time imaging with targeted therapy. Radiosensitizers amplify local radiation dose by twofold, and biomimetic carriers achieve prolonged circulation through immune evasion. An AI-driven approaches optimize personalized formulations based on patient-specific biomarkers. Clinical evidence …

Treatment Of Odontogenic Sinusitis With Oroantral Communication And Fistula: A Systematic Review And Meta-Analysis, Rana R. Alharbi, Omar F. Alnajar, Reham E. Almahdi, Salman A. Alrougi, Remas A. Alshehri, Ruyuf A. Alotaibi, Shahad S. Alharbi, Manal A Eltahir, Yahya A. Fageeh

Saudi Medical Journal

Objective: To assess the available data regarding medicinal, surgical, and combination therapy approaches for odontogenic sinusitis linked to OAC and OAF. Oroantral communication (OAC), an atypical connection between the oral cavity and maxillary sinus, commonly arises following upper jaw procedures, trauma, or infection. Chronic odontogenic maxillary sinusitis may result from OAC developing into an oroantral fistula (OAF) if treatment is not received. Recurrent infections and functional difficulties can be avoided by managing these illnesses effectively. Methods: A systematic search was conducted in National Library of Medicine's (PubMed [MEDLINE]) and Google Scholar for studies published between 2000 and 2024. A total …

Mental Health In Relation To Parental Absence: A Systematic Review, Mohammed Barry, Abdulaziz Alyahyawi, Heba Jafar Sabbagh

Saudi Medical Journal

Objective: To evaluate the literature based on the relationship between orphaned children and mental health, compared to non-orphaned children. Mental well-being of orphaned children is a profound intricate topic that connects with broader concerns of childcare. This systematic review aims to evaluate the literature regarding the relationship between mental health and parental absence. Methods: We conducted a systematic search of PubMed, MEDLINE, and Science Direct in October 2025, with 1017 screened studies. Six studies met the inclusion criteria. Independent reviewers performed quality assessments using the Newcastle-Ottawa scale (NOS). Subsequently, a meta-analysis was performed when possible. Results: Findings indicate that orphaned …

Toward A Technology-Enhanced Project-Based Learning Curriculum For English Language Learners, Lynn Wolfe

MITESOL Journal: An Online Publication of MITESOL

Project-based learning (PBL) has been demonstrated as an effective strategy for millennial and Gen Z students, particularly in K-12 contexts, but this teaching approach is not commonly used in adult ESL classrooms. This paper suggests that a technology-enhanced PBL approach may transform otherwise teacher-centered and outdated ESL classes by helping English language learners (ELLs) develop linguistic fluency along with technological fluency that is essential for the 21st century workplace. Collaborative PBL activities involving the use of digital tools are presented in the areas of listening/speaking, reading/vocabulary, grammar, and writing, providing a foundation for a technology-enhanced PBL curriculum designed for adult …

Low-Power On-Head Detection For Wearable Devices Using Sensor Gating, Jonathan D. Hurwitz, Yaaseen Mahomed

Defensive Publications Series

A multi-stage, power-efficient method for detecting when a wearable device is on the user’s head is disclosed. To reduce battery consumption, a cascaded verification process is used to control the activation of high-power components. An initial check of charging status and inertial measurement unit (IMU) data can identify movement and hinge-opening events. This is achieved through a differential analysis of orientation data from multiple IMUs to distinguish relative hinge motion from overall device movement. Once a hinge-open state is confirmed, mid-power neural processing units (NPUs) and eye-tracking cameras can be activated to perform a sparse, active stereo proximity check. This …

Mitigating Visual Prompt Injection Via Image Manipulation And Consensus Evaluation, Ashok Chandwaney, Mekhola Mukherjee

Defensive Publications Series

Contemporary vision-language models are vulnerable to visual prompt injections in which malicious instructions are embedded within images in a manner that is often imperceptible to human observers but legible to machine vision systems.  These hidden payloads can subvert the intended operation of automated agents, leading to unauthorized actions and inaccurate auditing.  This publication describes a defense-in-depth framework that utilizes image manipulation and consensus evaluation to mitigate such attacks.  Input images, such as application screenshots, are processed to generate multiple “sanitized” variants using techniques like bit-depth quantization (posterization) or luminosity-based thresholding.  These variants, in conjunction with the original image version, are …

Assessing The Relationship Between Online Information Verification, Overconfidence, And Media Literacy Learning, Tanya Notley, Sora Park, T.J. Thomson, Aimee Hourigan, Michael Dezuanni

Journal of Media Literacy Education Pre-Prints

To make informed decisions about a range of issues, people need to be able to determine if content they find online is trustworthy. To assess people’s ability to do this, we brought together findings from two nationally representative surveys of adult Australians. In the first survey (n = 3,852), we examined adult media use and asked respondents about their level of confidence in their ability to verify information online. The second survey then tested a subset of these participants (n = 2,115) to assess their ability to verify information online. The findings show that most adults have a …

Addendum To The Gossett Protocol: 120-Point Fixed, Jon S. Gossett

Defensive Publications Series

This disclosure specifies a theoretical hardware-level signal validation framework for non-penetrative neural interfaces. Building upon the Local Field Potential (LFP) detection concepts established in Revision 4, this architecture proposes a Parametric Voltage Thresholding mechanism (adjustable from -40mV to +40mV) and Phase-Locked Synchronization. By theoretically synchronizing a 1.5ms deterministic polling interval with the instantaneous phase of a neural wave, the system is designed to facilitate low-latency signal mirroring without the use of probabilistic interpretation layers. The proposed architecture is intended to operate within a hard-coded 38.5°C thermal envelope.

Methods And Apparatuses Of Deriving Fleet Counters For Firmware States, N/A

Defensive Publications Series

The technology relates to a framework for monitoring software state variables and deriving counters that record value change events using configurable counting techniques. The framework derives counters from software states by monitoring value changes in target variables and counting all value change events. The framework utilizes a fleet counter, a software-implemented memory storage which stores events that are readable by an external software entity. The framework may also select software state variables for monitoring based on the type of variable.

Keywords: Fleet counter, firmware states, framework, monitoring value changes, target variables, changed-to value, change-from value, software-implemented memory storage.

The Composite Virtual Projection System That Will Combine A Semi Octagonal Shaped Small Projection System And A Semi Octagonal Shaped Large Projection System Together To Provide A Greater Immersion., Punarjeewa Abeysekera

Defensive Publications Series

This paper describes a composite virtual projection system that will combine a semi octagonal shaped small projection system and a semi octagonal shaped large projection system together to provide a greater immersion. The entire composite virtual projection system will consist of a semi octagonal shaped small projection system and a semi octagonal shaped large projection system. The semi octagonal shaped small projection system will consist of 4 identical cyclically configured small projection configurations. And the semi octagonal shaped large projection system will consist of 4 identical cyclically configured large projection configurations. each cyclically configured small projection configuration of the semi …

A Software Simulated Pcie Device, N/A

Defensive Publications Series

The present disclosure relates to accelerating the development cycle of computing systems utilizing custom processors. By configuring a general-purpose processor as an endpoint on a standard communication bus to run a software simulation of an unmanufactured processor, system integration and host software development can proceed well before the physical processor arrives and is operational at a basic level. The simulated hardware features input/output connectivity mirroring expected production systems, a dedicated management endpoint for artificial error injection and debugging, and a network interface to interconnect multiple simulation cards for scale-up testing.

Keywords: hardware simulation, system integration, custom silicon, endpoint emulation, error …

Dynamic Routing For Multi-Agent Ai Workflows. Ai Token Cost In Metric Calculation., Roman Volkov, Yegor Kudryashov

Defensive Publications Series

This submission proposes a system that constructs multi-agent AI workflows dynamically at runtime by computing optimal paths through a live network topology of Large Language Model (LLM) providers, AI agents, humans, and services, the same way that routing protocol computes packet paths through routers. Considering Artificial Intelligence (AI) tokens as the new currency of intelligent automation, this submission embeds their cost into a routing metric. Through techniques of this submission, each LLM provider and AI agent's inference token cost for defined task can be used as part of weight in path computation.

When a routing algorithm builds a workflow, it …

Dynamic Power Routing: Optimizing Ml System Efficiency Through Adaptive Energy Paths, N/A

Defensive Publications Series

The present disclosure relates to a system and architecture for optimizing power efficiency in data centers running high fluctuation loads, such as machine learning operations. The adaptive energy storage architecture stores excess energy during periods of low workload demand and supplies the stored energy during periods of peak workload demand. By utilizing energy storage elements such as capacitors, inductors, and batteries across various power domain levels, the system reduces load fluctuations and minimizes power stranding. Inductors in series on the power path can act as a low-pass filter. Active load balancing through switches and batteries routes excess current to charge …