Nature has been a source of medicinal agents for thousands of years and an impressive number of modern drugs have been isolated from natural sources, based on their use in traditional medicine. Since ancient time's plants as well as fungus sources of medicinal compounds have continued to play a dominant role in maintenance of human health. Over 50% of all modern clinical drugs are of natural product origin and play an important role in drug development programs in the pharmaceutical industry. Mushrooms are an important natural source of food and medicine. Traditional aboriginals knew the importance of edible and wild mushrooms, and these are now being screened for their bioactivity in various ailments. We are aiming for this review is to compact a compressive scientific description of pharmacognosy, chemistry, and pharmacology of button mushroom (Agaricus bisporus), depending on published data and other available resources.

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Background: Stress can be described as a dynamic and reciprocal relationship between the person and the environment. Nursing is an occupation with a constellation of circumstances leading to stress. Work-related stress (occupational stress) can be damaging to a person's physical as well as mental status, which directly and indirectly affecting their quality and productivity of work. Hence, an attempt has been made with an aim to assess stress-perceived stress among staff nurses in Mysore city, India. Methodology: The descriptive cross-sectional study was conducted among 500 staff nurses selected from eight hospitals in Mysore City, India, using multistage sampling technique. Study duration was 5-month period and response rate was 100%. A structured questionnaire was administered to assess stress using Perceived Stress Scale (PSS) and Expanded Nursing Stress Scale (ENSS). Results: A cross-sectional study consisted of 500 staff nurses. Majority of the participants (467 [93.4%]) had diploma and 454 (90.8%) nurses worked on day shift. Nearly 277 (55.4%) had a moderate level of perceived stress and 249 (49.8%) had moderate occupational stress. Significant positive correlation (r = 0.144, P < 0.001) between ENSS and PSS. Conclusion: A positive correlation was found between perceived stress and occupational stress among staff nurses of Mysore City. This shows that those with general stress also have occupational stress.

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Nature is a big and important source of lots of things, in which plants are the living gifts of nature. Plants play an important role in various fields, but the role of these plants as herbal medicines is a big achievement. Drugs are obtained from plants have very low side effects and very popular in worldwide. Here, this review represents the pharmacology, pharmacognosy, and various molecular aspects of Quisqualis indica which may be helpful in near future based on available published data. This review opens the various doors or acts as a backbone for various researches in near future.

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Coronavirus disease-2019 is currently causing a world pandemic. The Kingdom of Saudi Arabia (KSA) reported its first case on March 2, 2020. Due to its potential rapid dissemination within the public and a large probability of a countrywide outbreak, along with the country's experience in battling another similar coronavirus (the Middle East respiratory syndrome–coronavirus), the KSA was among the leading bodies in the world for its swift community action and hospital preparedness.

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Objectives: The purpose of this study was to determine whether physicians' gender has any influence on patients' choice of their treating physician. Methods: A survey was conducted in different public places in Riyadh, Saudi Arabia, to determine preferences for the gender of a physician under various health-care aspects. Results: Three thousand and fifteen people participated in this cross-sectional survey. The majority of participants had no gender preference regarding their physician's attitude and professional competence. However, 49.8% of the female participants preferred a female physician and 37.4% of the male participants preferred a male physician when discussing family and psychological problems. Regarding general and genital examination, 65.8% and 86.4% of women and 53% and 67.5% of men, respectively, preferred to be examined by a physician of their same gender. The majority of women preferred a female physician during breast examination (90.1%) and delivery (71.4%). With regard to medical specialties, men preferred a male general surgeon (48.6%), male urologist (65.1%), and male orthopedic surgeon (54.4%). On the other hand, women preferred a female urologist (58.1%) and had no gender preference regarding their general surgeon (48.1%) and orthopedic surgeon (51.4%). Conclusion: Findings of this study highlight the difference in participants' choice for the gender of their treating physician in different medical specialties. Women participants preferred a female physician for psychosocial counseling and when visiting a gynecologist, obstetrician, or urologist. In addition, women of childbearing age favored a female physician during delivery. Men preferred a physician of the same gender when being treated by a urologist, general surgeon, or orthopedic surgeon.

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Vulvovaginitis is one of the most common gynecologic complaints in prepubertal girls. It accounts for 40%–80% of visits to pediatric gynecology services. It arouses parental anxiety because of the perceived rarity of vulvovaginitis in children, the fear of sexual abuse or concerns over lack of appropriate supervision, and hygiene in daycare or school. The majority of cases are due to nonspecific vulvovaginitis in which vaginal cultures will grow organisms considered to be part of the normal flora. The condition is easily managed with good perineal hygiene. In reluctant cases, oral antibiotics or local estrogen cream may be helpful. A small percentage will have a specific etiology and vaginal cultures will identify the pathogen. Most of these pathogens will be intestinal organisms, respiratory organisms, or sexually transmitted diseases. The isolation of sexually transmitted organisms should alert the physician to investigate for child sexual abuse. Other causes of prepubertal vulvovaginitis include systemic illness and foreign bodies which will result in foul-smelling bloody discharge most commonly toilet paper which can be removed by in-office vaginal irrigation but requires a cooperative child otherwise we may have to do vaginoscopy under general anesthesia.

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Background: The wide scope and spread of Coronavirus Disease 2019 (COVID-19) could lead to a true mental health disaster, especially in countries with high caseloads. Very few studies have assessed the impact on hospital staff. This study aimed to assess mental health changes in health-care workers (Northern Area Armed Forces Hospital-Kingdom of Saudi Arabia). Materials and Methods: This is a cross-sectional study. A survey questionnaire was designed and distributed among the participants, and the survey contained demographic questions and questions related to anxiety, worries, and fears, in addition to depressive symptoms and basic sleep profile. In addition, the psychological impacts, feelings, fears of developing COVID-19, and symptoms of posttraumatic stress disorder were assessed using the Impact of Events Scale-Revised (IES-R). Results: The mean age of the staff was 38.2 years. The examined staffs showed high levels of anxiety and depressive features: 19.3% had crying and depressed mood and 2.4% had loss of motivation; they depended mainly on social media as a source of COVID-19 information. Moreover, these features correlated positively with their Post-Traumatic features measured by the IES-R. Nearly 27.3% of the participants had their duty impacted by COVID-19 and 40.6% were affected financially. Conclusion: Our study identified a vulnerable group susceptible to psychological distress. Psychological support could also be included as counseling services and development of support systems among colleagues.

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Background: The use of smartphones has increased exponentially. Excessive usage of smartphones has been shown to have a negative impact on ocular health. This study aimed to evaluate the relationship between smartphone addiction and dry eye disease (DED) and determine the risk factors of DED in participants associated with smartphone addiction. Materials and Methods: This cross-sectional study was conducted in May 2017. Participants were selected from the Faculty of Medicine at King Abdulaziz University in Jeddah, Saudi Arabia. Stratified random sampling technique was used to recruit participants according to their academic year with an equal allocation of males and females. Only participants owning smartphones were included in the study. DED was assessed using the ocular surface disease index (OSDI) questionnaire and a short-version of the smartphone addiction scale (SAS-SV) was used to assess smartphone addiction among the participants. Data were analyzed using Pearson's Chi-squared test and binary logistic regression. Results: A total of 443 completed questionnaires were received, providing a response rate of 94%. Almost half of the participants were found to have DED (49.4%). There was no significant association between smartphone addiction and DED (P = 0.102). However, significant associations were observed between DED and contact lens use, eye drops, eye disease, and Vitamin A therapy (P < 0.05). Conclusion: Contrary to what was locally reported, DED had a lower prevalence. Despite no significant correlation with smartphone addiction, DED was found to be associated with the use of contact lenses, Vitamin A therapy, and eye drops. Several risk factors and clinical predictors of DED might exist, which highlight the importance of performing a complete clinical ophthalmological assessment.

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Objective: This study was aimed to compare the results of immunophenotyping by flow cytometry (FC) and immunohistochemistry (IHC) in the diagnosis of B-cell lymphomas and classic Hodgkin's lymphoma (cHL). Methods: This was a retrospective cohort study of 280 patients with chronic B-cell neoplasms and cHL performed between 2008 and 2013. Percentages of B- and T-cell markers detected by FC and IHC were compared regardless of the final diagnosis. Results: FC and IHC results were obtained from 280 patient medical records. There were 155 (55.4%) patients with non-Hodgkin's lymphoma (NHL), 110 (39.3%) with cHL, and 15 (5.4%) with chronic lymphocytic leukemia (CLL). Disparity between FC and IHC was observed for CD19 expression in cHL group where 73.6% (n = 81) CD19 expression was detected by FC and 59.1% (n = 65) detected by IHC (P < 0.02). In NHL group, a higher percentage (81.3%; n = 126) of CD19 was detected by FC as opposed to 61.3% (n = 95) detected by IHC (P < 0.0001). CD19 expression was no different between the two groups. CD20 expression assessed by FC (61.3%; n = 95) was lower than 85.2% (n = 132) detected by IHC in NHL group (P < 0.0001). Whereas no differences were observed in cHL, IHC performed better (100%; n = 15) than FC (66.7%; n = 10) for CD20 detection in CLL group (P < 0.01). In cHL and NHL groups, flow cytometric detections of CD21 of 61.8% and 56.1% were higher than 46.4% (P < 0.02) and 41.9% (P < 0.01) detection rates by IHC. No disparities were observed between FC and IHC detection rates for CD5, CD10, CD23, and CD30 expressions. Conclusion: There was a considerable amount of disparity between FC and IHC results, warranting further evaluation.

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Background: Insomnia is a major medical problem that is often associated with low health status and increased health-care utilization. Therefore, we conducted this study to determine the frequency of insomnia in a population presenting to the primary healthcare (PHC) clinics for health problems other than sleep disorders. Methods: We interviewed 336 consecutive patients attending PHC face-to-face by trained medical students. Validated questionnaires were used to evaluate insomnia, sleep quality, and daytime sleepiness. The insomnia questionnaire classifies patients into three categories: (1) no insomnia, (2) Level I insomnia with the absence of daytime dysfunction, and (3) Level II insomnia with the presence of daytime dysfunction. Results: Level I insomnia was reported by 19.3% and Level II by 57.1%. Patients with insomnia were older and had worse sleep quality. Apart from a higher prevalence of hypertension among patients with insomnia, there was no difference in other comorbidities between those with insomnia and no insomnia. None of the included patients has reported his/her complaint of insomnia to the treating general practitioner (GP), and none of them was diagnosed with insomnia by the GP. Conclusion: Insomnia and daytime dysfunction are very common in primary care population. Despite the frequent visits of these patients to PHC, none of them has reported that he/she complains to his/her GP, and therefore, did not receive any treatment for insomnia. Education of GPs is necessary to improve recognition, diagnosis, and treatment of insomnia.

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As of January 2021, 1 year has passed since the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first discovered, which is the cause of the coronavirus disease-2019 (COVID-19) pandemic that has infected almost 100 million people worldwide and caused almost two million deaths. In 2020, in an unprecedented scientific achievement, several vaccines were developed, underwent clinical trials, and were distributed worldwide. This was made possible, in part, by Operation Warp Speed, which promoted mass production of multiple vaccines through different technological platforms, relying on preliminary evidence to allow faster distribution as soon as clinical trials confirmed one or more of those vaccines to be safe and effective. The Kingdom of Saudi Arabia (KSA) was one of the very first countries in the world to grant emergency use authorization to the BNT162b2 vaccine, a new type of modified RNA vaccine developed by Pfizer-BioNTech. Here, we review various COVID-19 vaccines and the success of the vaccine rollout in KSA.

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Introduction: Organ donation is widely contentious among the Saudi population though remains largely understudied. In the aim to understand the public perception of organ donation, willingness to donate, and the reasons for donation refusal, we carried out this study. Methodology: A cross-sectional questionnaire-based study was conducted on a stratified-by-region random sample of 2596 Saudi residents in Riyadh area between 15 and 70 years of age in March 2010. The main outcomes were rates of organ donation awareness, willingness to donate, and awareness of Islamic opinion permitting organ donation. Secondary exploratory analysis was performed to determine reasons for organ donation refusal. Results: Seventy-six percentage of the sample had some background knowledge of organ donation; however, 41% were unwilling to donate their organs, with only 30.1% of our sample having had a prior knowledge about Islamic opinion about organ donation. Overall, of those who had background knowledge of organ donation, 79.5% thought that organ donation was important or very important. Respondents who are women, older, more educated, and in higher income group were more likely to be aware of organ donation (P < 0.05) and those younger than 35 years old were more likely to be unaware of the Islamic opinion (P < 0.001). The most cited reasons for donation refusal included the desire to be buried with complete parts (43.8%) (i.e., not disfigured), having an incomplete idea about brain death (24%), and because they thought that it was forbidden in Islam (15.1%). Conclusion: The level of organ donation awareness was comparatively high, but knowledge of the Islamic views of organ donation lacked among high portion of our sample, which partially explains the high organ donation refusal rate. There remains a large need to promote public awareness about the importance of organ donation and to clear the confusion of the Islamic view.

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Objective: The significant impact of COVID-19 pandemic may change the future of education. There was an abrupt obligatory transformation into e-learning. This study aimed to examine views of faculty members on the use of e-learning in Saudi medical and health colleges during COVID-19 pandemic, and their preparedness for e-learning in the light of the complete lockdown due to the pandemic. Materials and Methods: A descriptive cross-sectional study design was conducted in two parts. The first part was a pilot study aimed to provide valuable validation of the content of the major questionnaire study. The second part was a full-scale study designed to address the aim. An electronic questionnaire was prepared and distributed to reach a large number of faculties and primarily focused on three sections demographic information, experience with e-learning before and after COVID-19 pandemic, and preparedness for e-learning. Results: A total of 38 and 220 faculty members participated in the pilot and full-scale studies, respectively. The majority of respondents to the main questionnaire were male (73.2%), from Riyadh (42.7%), worked in governmental colleges (96.3%), and had different academic ranking and teaching experiences. Faculty members showed positive attitudes towards the use of e-learning which was tremendously increased post-COVID-19 (91.9%) compared to pre-COVID-19 (45.9%). Most of the participants were enthusiastic (82.3%) about and confident in using e-learning in teaching and learning. Yet, e-learning was not entirely used as a substitute for hands-on skill training and assessment. Conclusions: This study provides stakeholders with valuable standpoints indispensability of e-learning and the positive attitude and proficiency of teaching staff toward it. This urges furthering our institutional e-learning preparedness and engagement through resolving some appeared individual and infrastructural shortcomings. It is an appropriate time for overcoming barriers to e-learning/teaching as an integral teaching modality in medical and health colleges.

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Diabetic ketoacidosis is a manifestation of decompensated glycemic control. Two cases are outlined, representing severe cerebral edema in one case and multiple cerebral infarcts in the other. Favorable outcome was achieved in both cases with conservative management, excluding the immediate use of mannitol in the first patient and the use of thrombolytic or full anticoagulant therapy in the second.

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Objectives: Public awareness of palliative care (PC) is satisfactory in only twenty countries in 2013, which does not include Saudi Arabia in spite of the global efforts done to enhance the public awareness of PC. This study was conducted to evaluate the awareness, knowledge, and beliefs of the Saudi adult population about PC. Methods: A cross-sectional design study was conducted in December 2017 using a self-administered questionnaire survey that was sent through Google Docs to assess the Saudi general public on the awareness of PC. Results: There were 1987 (out of 3164, 62.8% response rate) Saudi adults who responded to the survey, in which 60.3% were males (mean age: 39.50 years, median: 39.0 years, and range: 15–77 years). There were 321 (16.2%) respondents who reported that they know PC and 454 (22.8%) answered that they have heard or were aware of PC. A total of 755 (38.2%) believe that PC improves the quality of life of sick people and 684 (34.4%) believe that PC can reduce the physical suffering of patients. Knowledge of PC was not statistically significantly affected by gender, place of residence, and marital status. On the other hand, employment and having higher levels of education led to better knowledge and more awareness of PC. Conclusion: The current study demonstrated that the knowledge and awareness of PC is still low among surveyed Saudis. There is a need for the government to advocate institutions to functionally devote programs and initiatives and promote literacy of PC in the general population. Nongovernmental sectors should also participate in programs to improve the knowledge and awareness of PC.

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Objectives: Our objectives are to estimate the prevalence of self-esteem and imposter syndrome, to compare their prevalence between genders and different academic years, and to determine their associated factors among King Saud University (KSU) medical students. Methods: Our study is a quantitative analytical cross-sectional study. Data were collected on the KSU campus. Participants in this research are KSU medical students including males and females from 1^st to 5^th year, with a sample size of 502. A stratified random sampling design was used. Data were collected through a self-administered questionnaire that includes the Young imposter scale, Rosenberg self-esteem scale, and sociodemographic factors. Results: The prevalence of low self-esteem and positive imposter syndrome is 23.6% and 42.1% (n = 573), respectively. There is a positive correlation between low self-esteem and positive imposter syndrome. There is a significant association between self-esteem and gender, mother's education, and Grade Point Average (GPA). Imposter syndrome is significantly associated with gender. Conclusion: Low self-esteem and positive imposter syndrome are prevalent among medical students, especially in the first few years and particularly in female students. These issues affect the mental health of medical students and thus need to be addressed to possibly improve the educational system.

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Evidence has shown that the state of the patient care environment has a direct impact on heightening the risks of hospital-acquired infections among patients admitted in hospitals. Moreover in view of the suboptimal standard of cleanings by housekeeping staff, there has been the quest for a better approach to reliably disinfect environmental surfaces in health-care facilities. The ultraviolet light has been known for its antimicrobial property and has been used in water treatment, food processing, and in-duct cleaning of ventilations. A recent introduction of its use for surface decontamination has raised interest among health-care facilities. However, studies have shown that, in spite of its relative success in other applications, there is doubt in its efficacy in decontaminating shadowed areas of the room, and therefore, may not be seen as justifying its capital intensiveness.

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Background: Hyperglycemia complicates the course of illness of many critically ill patients and contributes to the increased morbidity and mortality in adult intensive care units (ICUs). Objective: The objective of this study is to compare the effectiveness of a modified nurse-implemented insulin infusion protocol (NIIP) against the original protocol used in the adult ICUs, in terms of controlling hyperglycemia while averting significant hypoglycemia. Methodology: Blood glucose (BG) readings that were collected over 3 months in medical and surgical ICUs (SICUs) while on the original insulin infusion protocol were retrospectively reviewed. A modified insulin infusion protocol was prepared by a dedicated adult ICU quality focus group composed of physicians, nurses, clinical pharmacists, and quality representative. The rate of insulin infusion was increased by 10%–20% for the BG ranges above 13.1 mmol/L, allowing early transition from a mild-to-moderate scale. The new protocol was implemented for 2 months, and BG readings were compared to the results of the original insulin infusion protocol. Results: A total of 3490 BG readings in the medical ICU and 3006 in SICU were analyzed. Hyperglycemia was found in 1743 readings (26.83%) while on the original insulin protocol. When the modified insulin infusion protocol was applied, hyperglycemia was significantly less (19.83%, P < 0.0001) and significantly more readings were in the range of 7.8–10 mmol/L (52.57% vs. 46.54%, P= 0.0001). The reduction in hyperglycemia was more significant in SICU patients (19.20% vs. 31.27%, P < 0.0001). Meanwhile, severe hypoglycemia remained within the benchmark. Conclusions: The modified NIIP achieved fewer episodes of hyperglycemia in critically ill patients while avoiding the deleterious effects of hypoglycemia. This affirms the value of periodic monitoring and adjustment of ongoing protocols in ICUs.

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The phrase “publish or perish” has been used in an academic context since the early 1970s to emphasize the importance of publishing the findings of research. It has also been widely used to describe the pressure in academic institutions to rapidly and continually publish academic work. The pressure to publish, the lack of knowledge about publication ethics, and other factors have led occasional authors to indulge in practices that are outside of the realm of the ethical principles. This article highlights the ethics of writing and publishing, outlines the various unethical practices (misconduct) that must be avoided, and highlights the severe consequences that may be inflicted on an author, whether a junior or a senior one, following detection of misconducts in publishing. The title of this article is a modified form of the maxim “publish or perish” because it is an important responsibility that every author publishes ethically.

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Urinary tract infections are very significant public health concerns globally with most of them being caused by uropathogenic Escherichia coli (UPEC). The wide range of genetic makeup of UPEC due to the acquisition of specialized virulence genes located on mobile genetic elements called pathogenicity islands is the rationale behind colonization of the urinary tracts of humans as against diarrheagenic E. coli pathotype. Indebt understanding of the virulence mechanisms and pathogenesis of UPEC lies in the knowledge of the molecular techniques of UPEC which have advanced tremendously. This review has carefully summarized the unique virulence markers, the phylogenetic evolution, and molecular techniques used in the studies of pathogenesis and virulence of UPEC.

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The minimally invasive laparoscopic surgery has gained popularity among various surgical specialties. However, unique skills are required to perform it. These skills are not transferable from open approach and are associated with a steep learning curve. Therefore, they need to be obtained in a safe-simulated environment. Fundamental laparoscopic surgery program is currently considered the gold standard for assessing laparoscopic skills and a mandatory requirement for board certification in the United States and for promotional advancement of residents in different surgical residency programs. Despite its proven benefits and its superiority when compared to other training models, challenges exist related to its implementation outside North America. The lack of sufficient eligible examiners is the major obstacle. Once overcome, one can aspire to achieve the remaining standards required for full implementation.

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