Intessar Sultan

Proficiency in history-taking is foundational to safe clinical practice, yet traditional teaching methods offer infrequent opportunities for deliberate practice. This study evaluated whether an AI-powered virtual patient chatbot with a custom knowledge base could improve history-taking competence among fifth-year medical students during general medicine rotations. A mixed-method, quasi-experimental, non-equivalent control group design was used. The experimental group (N ≈ 157) engaged with four custom knowledge-based chatbot scenarios, while a control cohort (N ≈ 156) followed traditional training within the same curriculum. Assessment was performed using a validated Objective Structured Clinical Examination across two standardized cases, and user perceptions were gathered using an adapted Technology Acceptance Model survey from 105 students, with qualitative feedback from 32 trained students in a focus group. Compared to the control group, the experimental group demonstrated significant improvements in direct assessments (79.2% vs. 74.8%, p = 0.002) and indirect assessments (81.2% vs. 79%, p = 0.026). Participants reported a high user-perception score (80%) across usefulness, ease, attitude, and behavior. Focus group findings highlighted the chatbot’s value as a safe, flexible, feedback-rich tool. The chatbot-based training improved students’ performance and satisfaction and should serve as a supplementary aid rather than a substitute for real patient interactions.

Objective: To investigate the evidence derived from randomized controlled Nutritional Intervention studies on telomere length. Design: Systematic review of randomized controlled trials. Data sources: MEDLINE-PubMed and Cochrane Library databases as well as a manual search of systematic reviews from their inception to June 2025. Eligibility criteria for selecting studies: Randomized controlled trials comparing nutritional supplementation with a placebo or no treatment for changes on telomere length were included. Independent data extraction was conducted and study quality assessed. Main outcome measures: Telomere length (TL). Results: 21 RCTs were identified. The most consistent evidence was found in supplementation with Selenium and CoQ10 and Vitamin D. Promising but weaker evidence was detected in supplementation with Walnuts, fish oil, high protein diet. Limited uncertain benefit from Mediterranean Diet, Astragalus, hydrogen-rich water, and vitamin B. There were no effects form almonds, pistachios, zinc supplementation, or caloric restriction. Generally, the evidence is limited by small sample sizes, short durations, heterogeneous TL measurement methods, and risk of bias. Conclusions: Micronutrient supplementation with selenium, CoQ10, and vitamin D shows potential for healthy aging strategies. However, the available evidence is not yet sufficient for guideline-level recommendations, primarily due to the high risk of bias and substantial heterogeneity observed across the included randomized controlled trials (RCTs). Establishing a reliable evidence base will require large-scale, long-term RCTs that utilize standardized telomere assays.

This is a comparative multicenter cross-sectional study that evaluated the potential determinants of Z-scores among premenopausal Saudi women before and after the age of peak bone density. The Study concluded that for better BMD among premenopausal women, attention should be paid to early physical activity and healthy nutrition, especially vitamin D, during the childbearing period. Objective: To explore the potential determinants of Z-scores among premenopausal Saudi females in different age groups before and after the expected age of peak bone density (PBD). Methods: This multicenter comparative cross-sectional study was conducted in Madinah and Jeddah, Saudi Arabia, between August 2021 and March 2022. We recruited 886 premenopausal females (605 (68.3%) below and 281 (31.7%) at or above the age of 30). The structured pre-coded Arabic questionnaire included sociodemographic data, a BMD questionnaire, menstrual history, an Arab Teen Lifestyle Study questionnaire, and food frequency data. Metabolic Equivalents (METs) were calculated from physical activity. Analysis of serum PTH, 25(OH) vitamin D (VD) was performed with chemiluminescent immunoassay. BMD was measured with a calcaneal qualitative ultrasound. Results: Most women had age-matched Z-scores, with very few (24 (2.7%)) being non-age-matched with no identified secondary causes. Significant Z-score determinants before PBD were BMI (OR: 0.167, p = 0.003) and total METs (OR: 0.160, p < 0.005). After the age of PBD, significant predictors were parity (OR: 0.340, p = 0.042), history of vitamin D deficiency (OR: 0.352, p = 0.048), and BMI (OR: 0.497, p = 0.019). Conclusions: Early determinants of Z-scores among premenopausal women were the nutritional status and physical activity. After the age of PBD, parity and vitamin D status offer additional determinants. For better BMD, attention should be paid to early physical activity and healthy nutrition, especially for vitamin D, with intensification of efforts during the childbearing period.

Osteopenia and osteoporosis, are prevalent skeletal systemic conditions, cause weaker bones and an increased risk of fragility fractures. This work is aimed to evaluate the relation between bone-remolding markers and genotypes of four single nucleotide polymorphisms in young Saudi females (rs2297480 of farnesyl diphosphate synthase (FDPS), rs3736228 of Low-density lipoprotein receptor-related protein 5 (LRP5), rs1234612 of sclerostin (SOST), and rs9934438 of Vitamin K epoxide reductase complex subunit 1 (VKORC1) ). For this purpose, 750 premenopausal females aged 18 to 40 years old, either university students, postgraduates, or university employees were recruited and divided into three groups according to bone mineral density BMD (g/cm²) divided by T score into osteoporosis (n = 12), osteopenia (n = 147), and normal (n = 591). Serum SOST, BALP, calcium, phosphate, ALP, albumin, beta-CTXs and human VDR levels were determined. TaqMan SNP Genotyping assays were used to genotype four polymorphisms using real-time PCR (applied biosystem). Results showed that BALP, CTX-1 and SOST were significantly higher in the osteoporosis and osteopenia groups than in the normal group. Bone mineral density readings were considerably lower in females with the GG genotype in FDPS rs2297480 and TT genotype in LRP5 rs3736228, which increase the risk for osteopenia by 3. 6-fold and 3. 06-fold than control respectively. Also, females with the TT genotype in LRP5 rs3736228 have decreased average values for Bone Mineral Density. In conclusion, the GG genotype of FDPS rs2297480 and the TT genotype of LRP5 rs3736228 was shown to be strongly associated with osteopenia in young Saudi females with low bone mineral density and SOST levels.

Background: Numerous studies on coronavirus disease 2019 (COVID-19) vaccination safety have been conducted in Saudi Arabia. Even though there is less evidence comparing the side effects of different vaccines and a few of them studied the side effects of mixing different platforms of vaccines. Objectives: This study aimed to evaluate the type and severity of adverse effects following COVID-19 vaccination based on the type and platform of received vaccine and to determine factors that contribute to the occurrence of these side effects. Methods: This cross-sectional comparative study was conducted in Saudi Arabia from January to the end of February 2022 among COVID-19 vaccine recipients through an online survey. Based on the type of vaccines received, we categorized our participants into two groups - those who received two doses of either the Pfizer or the AstraZeneca COVID-19 vaccines, and those who received mixed vaccination regimen (one dose of Pfizer and one dose of AstraZeneca). Results: The study included 1,340 participants, of which 56.3% received two doses of the Pfizer vaccine while (7%) received two doses of the AstraZeneca vaccine, and 8.8% received mixed vaccines (one dose of the Pfizer vaccine and one dose of the AstraZeneca vaccine). Pain at the injection site was the most frequent local symptom (37.9%) followed by swelling±redness (27.6%). The local adverse reactions were nearly equal in AstraZeneca and Pfizer vaccines, whereas these were significantly lower in those who received mixed doses (p<0.001). Fever was significantly higher in mixed vaccination regimens compared to other types (p<0.001). The male gender who received the Pfizer vaccine were at higher risk of developing an adverse reaction following vaccination. Unusual side effects (sleep disorders, menstrual irregularities, and symptoms suggestive of diabetic neuropathy) were also reported. Conclusion: The results suggest the overall safety of Pfizer and AstraZeneca vaccines as well as the mixed vaccination protocol. A heterologous regimen was associated with fewer side effects compared to homologous vaccines. Further studies are needed to assess the long-term side effects.

Background: Clinical trials for COVID-19 vaccines initially excluded pregnant women. However, observational studies revealed a relative safety of the vaccine during pregnancy therefore association between different types of COVID-19 vaccination and the risk of abortion must be studied. Objectives: The objective is to explore the possible association between abortion and different types of COVID-19 vaccination in Jeddah. Methods: This was a retrospective cross-sectional study done in three private general hospitals in Jeddah using electronic medical records and phone interviews of pregnant women who were admitted with abortion. Women were then interviewed for their vaccination data (type, dose) and their current pregnancy outcome (aborted or not). Results: Medical records of 214 women diagnosed with abortion were included; 13.1% of them managed to continue their pregnancy. Vaccinated women (86%) had significantly earlier gestational age (p=0.031), higher hypertension (<0.001), and lower positive consanguinity (35 years (OR: 3.1, 95% CI: 1.34-6.97, p=0.008), diabetes (OR: 0.09, 95% CI: 0.01-0.89, p=0.040), and positive consanguinity (OR: 0.12, 95% CI: 0.02-0.63, p=0.012). However, spontaneous abortion did not have an increased odds of exposure to COVID-19 vaccines (OR: 1.07, 95% CI: 0.21-5.49, p=0.937). Conclusion: COVID-19 vaccination is not associated with an increased risk of abortion in women vaccinated during their first or second trimesters. Further clinical trials are needed to support the evidence of the safety of early vaccination of pregnant women.

BACKGROUND: Venous thromboembolism (VTE) is associated with substantial mortality as well as morbidity and is largely preventable among hospitalized obstetric women. However, thromboprophylaxis is underutilized in most hospitalized patients. OBJECTIVES: To evaluate VTE risk and adherence to local thromboprophylaxis protocol among hospitalized pre- and postnatal women. METHODS: This retrospective study was conducted at East Jeddah Hospital, Jeddah, Saudi Arabia, in 2020. The electronic record database of the hospitalized pregnant Saudi women during the years 2018 and 2019 was reviewed. Based on the local hospital protocol, the risk stratification was reassessed by researchers, and the hospital adherence to the prophylaxis was reviewed separately for antenatal and postnatal women. RESULTS: One thousand and ninety-five electronic records (539 antenatal and 556 postnatal) were reviewed. The postnatal group showed a significantly higher risk compared with an antenatal group (62.2% vs. 11.7%) (P = 0.000). There was a highly significant difference between risk categories assessment by the physicians and the researchers in both groups (P = 0.000). Thromboprophylaxis was overutilized in the low risk (5% heparin and 41.4% heparin and mechanical devices for antenatal and 17.08% heparin and 6.1% heparin and a mechanical device for the postnatal group) and underutilized in intermediate groups (50% no prophylaxis in antenatal and 51.5% mechanical devices in the postnatal group). There was less adherence to documentation in postnatal as compared to antenatal group (83.6% vs. 95%, P = 0.000) for risk documentation and 85.3% versus 91.5% for physician signature (P = 0.001). Thromboprophylaxis was ordered for 21.3% of antenatal (12.2 heparin, 3.5% mechanical, and 5.6% both) and 23.7% of postnatal patients (16.5 heparin, 2% mechanical, and 5.2% both). There were no reported VTE events or bleeding complications. CONCLUSION: There was a considerable VTE risk among hospitalized obstetric patients which peaked during the postnatal period. Physicians showed good compliance to local VTE protocol with no reported VTE events or drug-induced bleeding. However, the implementation of prophylaxis is associated with both under and overutilization. There is a need for increasing the physicians’ awareness of optimizing VTE risk assessment and documentation for hospitalized obstetric patients.

The coronavirus (COVID-19) pandemic has created an unprecedented problem in people's lives around the world. Lockdown measures altered the routine lifestyle aspects of people including diet, exercise, sleep, stress, smoking, job status, recreation, and application of modern technologies. Understanding the lifestyle profile of individuals could help in designing effective interventions to minimize the risk factors of COVID-19-related health problems. The aim of this research is to investigate the lifestyle changes among adults living in Saudi Arabia (SA) during the COVID-19 pandemic. A cross-sectional survey study was done to investigate the lifestyle changes during the COVID-19 pandemic in Saudi Arabia from August to September 2020. A pre-designed questionnaire was used for data collection and distributed online through social media. The questionnaire included items about sleep patterns, dietary habits, physical activity, employment status, recreation activities, use of social media, and screen time before and during the pandemic. A total of 338 adults with a median age of 40 years participated in the study. During the pandemic, employment, smoking decreased significantly (53.3 vs. 55.6%, p<0.001 & 15.7% vs. 18.3%, p=0.049) with significant increases in daily intake of fruits or vegetables (47% to 60.2%, p<0.001), caffeinated beverages (seven or more times caffeine, 3% vs. 0.9%, p<0.001), and water (more than eight water cups daily, 18.4 vs. 11.9, p<0.001). Overweight group increased significantly from 28.5% to 32% (p=0.009). Sleeping more than nine hours increased significantly from 8.3% to 21.8% (p<0.001) with increasing sleeping aids from 11.6% to 15.7% (p<0.001). Both the screen and the social media times increased significantly for six or more hours daily (14.8% vs. 35.3% and 9.5% vs. 28.2% respectively, p=<0.001 for both). There were significant decreases in socialization (91.4% vs. 37.8%) and fast food (71.98% vs. 47.04%), and increases in physically inactivity (19% vs. 5.3%) and stress (90.8% vs. 85.2%) (p<0.001 for all). Most participants perceived stress during the pandemic (307, 90.8%). There were remarkable behavioral changes in all aspects of the lifestyle of the participants living in SA during the COVID-19 pandemic with some positive effects on smoking and dietary habits. However, negative changes included unemployment, physical inactivity, sleep disturbances, social isolation, and excessive weight gain. There is a need to study the possible consequences of such changes on the future population health in SA.

Background: Pfizer-BioNTech vaccine was the first of all coronavirus disease (COVID) vaccines to be used in Saudi Arabia. There have been over 17 million doses already administered to the general public in order to successfully reach herd immunity. Objective: The study aimed to explore the side effects of the Pfizer-BioNTech vaccine. Materials and methods: This is a cross-sectional study comprising a sample of 386 participating adults of different age groups and genders. A validated modified questionnaire was distributed as a Google form to residents of the kingdom via social networking sites from February to March 2021. The questionnaire included questions regarding participants’ socio-demographic details, vaccination details, and symptom analyses items. Results: The most common to least reported symptoms were local pain (79.3%), fatigue (42%), muscle pain (39.1%), local swelling (27.7%), joint pain (23.1%), headache (21.8%), fever (21.0%), chills (15.5%), local redness (14.8%), nausea (7.3%), with no reports of anaphylaxis, facial paralysis or syncope. There were more side effects after the second dose than the first (p<0.001). Significant predictors of a higher number of side effects after both doses of the vaccine were the female gender ((p<0.001)) and the presence of allergies (p=0.044). Conclusion: Pfizer/BioNTech vaccination was quite safe with no reported anaphylaxis or serious events. The most common reported side effects were local pain and fatigue. Symptoms began within 24 hours and were mild to moderate in nature with a regressive course, especially after analgesics. More side effects were experienced after the second dose than the first. The significant predictors of side effects were the female gender and a history of allergies.

Type 2 diabetes mellitus (T2DM) is a prevalent, chronic, non-communicable disease that requires continuous multidisciplinary health care. Electronic health (eHealth) refers to “the transfer of health information resources and health care services using different electronic platforms.” This may have an effect on diabetes self-management (DSM). This study aimed to identify the use of eHealth among patients with T2DM as well as its association with DSM. An analytical cross-sectional study was conducted online using a newly adapted three-part questionnaire using Google Forms through different social media platforms. A total of 2,228 adult Saudi T2DM patients from different provinces were selected based on the non-probability voluntary response sampling technique. The survey included demographic, clinical, and eHealth data, and diabetic self-care management. The study results revealed an average DSM score of 5.2/10, and 74.1% were receiving diabetes care at primary health care centers. Of these, 87.1% used eHealth, mainly through Google (55.7%) and other social media (12.9%), and were satisfied with the quality of health care (70.4%). Moreover, 82% wanted to discuss the eHealth information with their physicians, but some (34.5%) had no online access to them. eHealth dependency was 44.2% and was associated with a lower mean DSM (5.6 vs. 5.3; p = 0.000) with significantly lower health care use (6.7 vs. 5.6; p = 0.000) and glucose management (4.7 vs. 4.0, p=0.000) compared to the independent group. The DSM total score was a significant predictor of eHealth dependency (OR: 1.022; 95% CI: 1.006-1.039; p = 0.007). Most Saudi T2DM patients with an average DSM use different eHealth resources and are satisfied with their quality. Dependency to eHealth is significantly associated with lower DSM, especially for health care use and glucose management, a finding that could affect patient outcomes. Still, patients need to communicate with their physicians in person who should have different options for remote consultation, such as telemedicine, to support their patients.