European Journal of Molecular & Clinical Medicine

Intraoperative near-infrared (NIR) fluorescence imaging is a novel technique that combines the use of a fluorescent agent with a dedicated near-infrared camera system, to allow real-time visualization of lymph nodes, tumor tissue and/or vital anatomic structures for surgical guidance (Vahrmeijer et al. 2013). NIR light ranges in the wavelength of 700- 900 nanometers, is invisible to the naked eye and can only be detected with dedicated NIR imaging systems, which are currently available from various commercial companies. Fluorescent agents are mainly administered intravenously at a given time prior or during surgery, in order to enable realtime imaging during the procedure. The time of injection is dependent on the biodistribution of the specific agent. After injection the fluorescent agent is cleared by either the liver or kidneys and accumulates in the target (i.e. lymph node, tumor or vital structure) by either physiological processes (enhanced permeability and retention effect), specific targeting or through their clearance route.

Aim: We aimed to investigate the action mechanism of Zhengyuan capsule (a registered proprietary Chinese medicine) against chemotherapy-related fatigue (CRF). Methods: BALB/c-nu nude mice model with human lung adenocarcinoma A549 xenografts was constructed by injection of A549 cell suspension. The xenografted mice were randomly divided into model, cisplatin and cisplatin+Zhengyuan groups (n = 20 each). The cisplatin group was given an intraperitoneal injection of 5 mg/kg cisplatin every 3 days for 21 days. The cisplatin+Zhengyuan group was given an intragastric administration of cisplatin and 25 mg/kg Zhengyuan capsule each day for 21 days. Normal control and model groups were administrated with equal amount of saline. Forced swimming assay, tail suspension test, open field test, hepatic glycogen assay, blood analysis, and bone marrow smear was performed. Results: The cisplatin group developed CRF after receiving chemotherapy. When compared with cisplatin group, the cisplatin+Zhengyuan group exhibited longer exhaustive swimming time (p

Laparoscopic ventral hernia and incisional hernia repair has now become a standard technique. However, the disadvantage of this technique is the contact between the mesh and tacks and the viscera. The objective of this article is to describe totally laparoscopic extra-peritoneal ventral and incisional hernia repair to avoid this problem. We developed a reverse Dulucq’s technique for laparoscopic inguinal hernia repair described as Reverse Totally Laparoscopic Extra-Peritoneal ventral hernia repair (R-TEP).

Aim: The aim of this study was to analyse the expression at the mRNA level of cytochromeb, subunits COI, COII, COIII of complex IV, ATP6 and ATP8 and to perform aquantitative analysis of the activity of ATP synthase as complex V of the respiratory chain, responsible for ATP synthesis and break down of ATP to ADP in breast cancer. Methods and Results: The level of gene expression at the mRNA level was evaluated on the basis of the light intensity of fluorochrome or fluorescein in the cells. Determination of the activity and location of the ATP synthase in cells was carried out using hybridization. In the formulations of breast cancer there was a higher genes expression at the mRNA level for all the examined genes as compared with non-cancerous tissue. The ATP activity was also higher in preparations obtained from breast cancer cells compared with the control tissue. Conclusions: The results confirm mtDNA incorporation to nDNA in neoplastic cells. They point to increased expression at mRNA level for COI, COII, COIII, ATP6 and ATP8 in breast cancer cells compared with control tissue. Increased amount of ATP synthase points to increased ATP in a neoplastic cell.

There are many clinical evidences that hyperuricemia is a risk factor for the development of peripheral carotid and coronary vascular diseases. However, the mechanism of elevated uric acid concentration in biological systems is not yet clear. In the present work Fourier transform infrared (FT-IR) spectroscopy was used to evaluate the mechanism of calcification and plaque formation in carotid arteries in hyperuricaemic patients. Comparison between the spectra of carotid arteries from patients with elevated uric acid values and spectra obtained from patients with normal uric acid values showed structural changes of the characteristic spectral bands in the region 4000-500 cm-1. These changes were related with changes in the concentration of the serum uric acid and the clinical history of the patients. The intensity decrease of the infrared bands in the region 1650-1500 cm-1 was associated with the decrease of the apolipoprotein ratio, ApoI/ApoII, which corresponds to HDL (High Density Lipoproteins) and the regulation of the LDL (Low Density Lipoproteins), which are related to oxidation stress. The infrared band at 1467 cm-1 indicated the presence of urea components as a result of the metabolic pathway. The shape and the intensity of the bands between 1250-900 cm-1 depend on the glycation-end products of the diseases. SEM-EDX chemical analysis showed fibril formation and molybdenum release in hyperuricaemic patients.

Chemotherapy remains one of the principal modes of treatment for cancer patients. Despite advances in anticancer agents for multiple cancers, development of resistance to classical chemotherapeutic drugs and targeted drugs continues to be a major challenge. Drug resistance which can be either intrinsic or acquired, leads to treatment failure and tumor progression. Drug resistance occurs because of mechanisms that are associated with individual cancer cells or through mechanisms that relate to the microenvironment within tumors. Multiple molecular determinants of intrinsic and acquired resistance including genetic, epigenetic factors, as well as other factors which act at the genomic or cellular level have been identified. This review provides a conspectus on some of the recent discoveries on mechanisms of anticancer drug resistance and the possible ways to revert resistance and thereby improve cancer therapy.

Barbiturates are derivative of barbituric acid which acts as central nervous system
depressant. The primary detection of barbiturates is carried out by the presumptive tests
viz. Dille Koppanyi test and Zwikker’s test. A comparative study was done in order to
determine whether there are any differences in the results of the two tests and to find out
the test with more consistency. Drug samples containing Phenobarbital viz. Gardenal-30
and Gardenal-60 were used in the study. Solution mixtures of 9 different ratios were
prepared in the ratios 1:9, 2:8, 3:7, 4:6, 5:5, 6:4, 7:3, 8:2 and 9:1 comprising stock solution
of Phenobarbital and solvent (Methanol AR). Both the tests were performed upon the
samples at different proportions on spot tile and test tubes and the absorbance values
(given by UV/VIS Spectrophotometer) for all the various test results at different
concentrations were compared. The study demonstrated that Dille-Koppanyi test showed
better results after interpretation of the absorbance values using Independent sample ‘t’
test and Coefficient of variation. A mean value of 2.85 was found for Zwikker’s test and a
mean value of 3.19 for Dille-Koppanyi test. A significant difference of p<0.01 was obtained
between the results from the two tests. Further, a better consistency was found from the
absorbance values of Dille-Koppanyi test as compared to the absorbance values of
Zwikker’s test which is shown by the values of Coefficient of variation that was found to be
higher for Zwikker’s test (2.00 and 5.86 for Gardenal-30 and Gardenal-60 respectively)
and lower for Dille-Koppanyi test (0.78 and 2.26 for Gardenal-30 and Gardenal-60
respectively). In cases of trace amounts of drug sample being recovered from crime scene
suspected to be barbiturate, primary detection can be efficiently done directly using Dille-
Koppanyi test instead of Zwikker’s test which will lead to a better outcome in the
investigation.

Background and Objectives
Early Childhood Caries (ECC) is a chronic disease of childhood affecting the primary
dentition. ECC begin early in life and can affect the quality of life of child. It is also termed
as nursing caries or baby bottle tooth decay. It has a multifactorial etiology and salivary
parameters are considered as one of the important etiological factors of ECC. The present
study was done to determine the level of salivary calcium and phosphorus in children with
ECC, severe ECC and caries free. The main objective of the study is to determine the
correlation between calcium and phosphorus level and to compare it with the three groups
of children with different caries experience.
Materials and Methods:
It is a cross-sectional observational study conducted at Saveetha Dental college and
Hospitals. Children between 3-6 years were examined and 20 caries free, 20 children with
ECC and 20 children with Severe ECC were recruited for the study. The examination and
sample collection were done by a single qualified Pediatric dentist. The samples were
collected and analysed for salivary calcium and Phosphorus.
Results: The results showed that there was a statistically significant differences in salivary
calcium and phosphorus levels among caries free, ECC and Severe ECC children.
Conclusion:
1. There was a significant difference in salivary calcium levels among caries free,
ECC and Severe ECC children
2. There is a significant difference in salivary phosphorus level among caries free,
moderate ECC and Severe ECC children

Hydrogels are a group of hydrophilic polymers which contain more than 10% of
water content in their structure. They have got a specific structure and also compatibility
with different condition of use. Flexibility of hydrogels, primarily due to its water content,
makes it possible to use them in a myriad of applications ranging from industries to
biological uses. Their application in medical field is popular due to their biocompatibility
and inert nature. Hydrogels have a wide range of application in the field of dentistry also.
These can be used as a better substitute for some of the materials used in dentistry. This
article describes then various avenues for application of hydrogels in dentistry

It has been observe in past years that the academics have instigated string
matching algorithms in several turfs to extract and find the undisclosed key RSA
algorithm or any other encryption method for discovering the intruder or malicious
pattern in imposition detection system , the DNA matching, carbon chain matching .
This article has a signified aim to analyse ,suggest and attain an algorithm which is
classified for discrete pattern matching in different mode and moreover more efficiently
and effectively. It has been designed for any pattern or type of string whether a
character string , decimal value , wild character or any special symbol using your
ASCII value.

Tumor budding is the histological phenomenon seen as a detached, discohesive small cluster
of cells in the invasive tumor front. Tumor buds may provide a histological means for the
assessment of epithelial-mesenchymal interaction and facilitate early prediction of
prognosis.The present study aims to assess the prognostic significance of the tumor budding in
oral squamous cell carcinoma(OSCC). Detailed Histopathological scoring of the oral
squamous cell carcinoma tissue and lymph nodes including the evaluation of tumor budding
was performed by two individual observers retrospectively. The association between various
clinicopathological parameters and the budding index was analyzed using chi-square test and
fisher’s exact tests. Tumor budding was demonstrated in the invasive tumor front of all OSCC
cases. High-intensity tumor budding was seen in stage 4 cancers with tumor size of > 4cms.
Histologically, they were related to deep and extensive tumors, having an invasive front with
infiltrative cells in groups or cords, dense stromal type in association with mild inflammation
invariably. All of the cases with lymph node metastases were tumor budding positive. Thus this
study emphasizes the importance of tumor budding evaluation in regular pathology practice in
the management of OSCC cases.

The Internet of Things is the notion of linking any gadget to the Internet and other
connected devices (provided that it has an On/Off switch). It is a gigantic network of linked
objects and people – all collecting and sharing information about their use and the
surrounding environment. This includes an extraordinary number of items in all shapes
and sizes – ranging from smart microwaves that automatically cook your food for the
proper time period to self-driven cars whose complex sensors detect objects along their
path, to wearable fitness equipment that measure your cardiac velocity and the number of
steps taken on that day. There are even linked footboards that can track how far and
quickly they are being thrown and recorded for future training reasons using an
application. By taking advantage of major Bluetooth vulnerabilities, a cybersecurity expert
pirated a Tesla Model X in less than 90 seconds. For identical reasons, other automobiles
using FOB (wireless) keys have undergone assaults to open and start their automobiles.
Threat actors have identified a technique of scanning and replicating the interface of these
FOB keys to rob the corresponding cars with no alarm. If high-tech machines such as a
Tesla are exposed to an IoT data leak, every smart device is vulnerable to it.

Elderly person of 80 years of age and older presents a specific challenge to anesthetists,
who needs toacquire and maintain skill and expertise in the management of such patients.
Departments should havea lead clinician with an interest in the care of the elderly.
Development in anesthesia and operative techniques hasconsiderably reduced morbidity
and mortality in the elderly patients.Several anesthetic techniques have been used for
elderly patientsincluding general anesthesia, regional anesthesia, intravenoussedation and
monitored anesthesia care. However, anesthesiarelatedmortality in these patients is still
high. All elderly patientsundergoing surgical procedures require a preprocedural
evaluationto assess the risks of anesthesia and procedure and to manageproblems related
to the preexisting medical conditions, monitoringpatients during intraprocedural and
postprocedural periods aswell as postprocedural management. This article considers
theage-related physiological changes, preprocedure assessmentand preparation, anesthetic
techniques, intraoperative care andpostoperative care. Age does not obtund the perception
of pain. Acute and chronic pain management teams should be available totreat the elderly.
Prophylaxis for Thrombo embolic disease should initiated to prevent further complications.

Background
Health care associated infections (HCAI) are one of the most serious and complex worldwide health problems. Commitment to standard precautions (SPs) and infection control (IC) measures are important to all healthcare providers (HCP) to prevent occupational exposure to hazardous materials. Healthcare workers (HCWs) are particularly more prone to blood-borne pathogens through contact with infected blood and body fluids during their work. It is based on the presumption that every person is infected or colonized with an organism that could be transmitted in the healthcare setting and thus health care workers need to apply infection control practices during the delivery of health care.Health care worker at risk of health associated infection (HAIs) due to their exposure to the patients during carrying out their duties. Health care workers in primary health care centers are the first to detect and to prevent the spread of infection. Standard precautions are regarded as an effective means for protecting health care worker, patients and community.
 Aim of the study: The study aimed to assess the level of Knowledge and practices of infection control standard among health care workers at the primary healthcare level in Makkah City.
Method:  A cross sectional study enrolled HCWs (doctors, nurses, lab workers) from 10 primary healthcare (PHC) centers in in Makkah, during the April to June, 2021, Our total participants were (200)
.Results:the knowledge regarding standard precautions of infection control study results show the majority of participant had average information were(55.0%) while weak knowledge were(21.0%) the data ranged from(5-18) by mean ±SD(12.15±3.11), also the Nationality is a significant relation between knowledge and Practices increase in the non-Saudi healthcare workers were mean+ SD respectively (12.980±2.606, 6.603±1.510), compared to the Saudis had adequate level of knowledge Practices where (T=-5.33, T=-6.152) and P-value=<0.001.
Conclusion: There was a gap between the actual and desired Knowledge and practices of Healthcare providers regarding IC. Continuing education programs are needed to improve their Knowledge and practices scores towards SPs and IC measures in order to reduce HCAI, inadequate knowledge particularly concerning the disposal of sharp instruments and hand hygiene were also detected. The studies highlighted the necessity of the provision of a comprehensive training program to ensure compliance with infection control measures by HCWs.
 

Background: In the last decade, teaching of the knowledge and skills required for the practice of evidence-based medicine (EBM) is taught through standalone courses and workshops in classrooms away from the clinical practice such as research centers.Objectives: To determine the level of knowledge, familiarity with sources and attitude towards Evidence-based Medicine among Family Medicine trainees in MakkahRegion 2017 as well as to identify barriers for its practical application.Subjects and methods: It was a cross-sectional included a representative sample of Family Medicine trainee enrolled in joint programs of FM in MakkahRegion (Makkah, Jeddah, and Taif).A self-administered valid questionnaire was used for data collection, including personal data, opinion, and attitudes of participant towards EBM, knowledge of EBM terms, familiarity and use of electronic EBM sources.Results: One hundred and eighty-six Family Medicine residents were included in the study. Exactly two-thirds of them were females. Majority of the participants (97.8%) were Saudis. The overall score of opinion and attitude towards EBM ranged between 22 and 40 with a mean of 34.09 (±) 3.19. Female residents expressed higher attitude score towards EBM than male residents (mean rank was 98.91 versus 82.68.(This was borderline significant, p=0.051. The overall score of familiarity and use of electronic EBM source ranged between 4 and 12 with a mean of 9.80 (±) 1.95. R1residents expressed the highest familiarity and use of electronic EBM source score (mean rank was 104.27) whereas those of R4 level expressed the lowest score (mean rank was 69.07), p=0.046. Also, residents of Makkah Family medicine residency program had the highest familiarity, and use of electronic EBM source score (mean rank was 108.93) whereas those of Jeddah program had the lowest score (mean rank was 75.25), p=0.001. The overall score of EBM knowledge ranged between 11 and 44 with a mean of 33.51 (±) 7.16. Lack of EBM source in the native language, lack of time to access EBM insufficiency of essential EBM skill in most areas of medicine and there is little or no evidence to guide practice were the most frequent barriers for applying EBM in practice.
Conclusion: Overall, family medicine resident physicians in the MakkahRegion showed a welcoming attitude towards evidence-based medicine, suboptimal knowledge of EBM some significant terms.

Background
      Vitamin D is one of the major vitamin and very essential for maintenance of normal growth and development of strong bones. It is often referred to as the "sunshine vitamin" because it can be synthesized in the body from the ultraviolet rays provided by the sun. Vitamin D is known to have essential roles in the human body. However, the case of vitamin deficiency is reported to increase in many adult worldwide, especially in Saudi Arabia. Vitamin D deficiency is associated with numerous chronic diseases including cancer, heart disease and diabetes type 1 and 2. It is currently estimated that one billion people suffer from vitamin D deficiency worldwide. Sunlight is the main and natural source of vitamin D and most foods contain very little amount of it. The main action of vitamin D is to help calcium and phosphorus in our diet to be absorbed from the gut.
 Aim of the study: The study’s aim was to assess the knowledge regarding vitamin D deficiency ​among female adult attending the primary health clinic at Makkah at Saudi Arabia
Methodology: Across sectional descriptive study was conducted among female adult attending to clinic in PHC at Makkah, Saudi Arabia city, during the October to December, 2019. Our total participants were (150).  Results: Major findings of the study were (38%) adult women were in the group of age between 25 to 35 years. The majority of the women (84.67%) “married” status. The majority of the women were (49.33) secondary level of education, regarding chronic disease, most of the mothers in the study were found to have no chronic disease were (62.00%). The income level of (56.0%) of the respondents ranged average, the majority of the women were (42.0%) Sources of knowledge doctor.
 Conclusion: Vitamin D deficiency is prevalent among the various age groups in our country due to various factors. So, Awareness programmes have to be conducted to make the general public including the females aware of the vitamin D, its deficiency, causative factors and the preventive measures. So this study was done this study was conducted assessment the knowledge towards vitamin D deficiency, sun exposure, supplementation in a sample of adult female attending the primary health clinic at Makkah, Saudi Arabia Saudi Arabian.

Background:
Psychiatric disorders in Saudi Arabia, mainly depression are estimated to have high prevalence. More than 6 decades ago, the World Health Organization (WHO) defined health as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.” Bircher, 2005 defined health as “a dynamic state of well-being characterized by a physical and mental potential, which satisfies the demands of life commensurate with age, culture, and personal responsibility”. Health has been defined by various authors, who have always emphasized its mental component.In recent years, there has been a sharp increase in the number of older persons worldwide. Globally, more than 350 million people of all ages suffer from depression. Elderly persons are more vulnerable to depression. By the year 2020 depression would be the second major cause of disability adjusted life years lost, as reported by the World Health Organization. depressive symptoms are common among older people and are associated with disability, morbidity and mortality. Depression is a mental illness which causes persistent low mood, a sense of despair, and has multiple risk factors.
 Aim of the study: To assessment the determinant and prevalence of depression among elderly attendees in primary health Care center in Makkah Al-Mukarramah.
Methods:Methods: A cross-sectional study was conducted among elderly patients attending to clinic in PHC at Makkah, Saudi Arabia, during the October to December, 2019, validated questionnaires concerning demographic data and knowledge scores on depression among elderly. Our total participants were (400). Results:show that the Family history of depression (70.0%) is the most common clinical variables also show that of the(45.0%) participants have negative depression , (23.0%) have moderate depression,  and the data ranged from(0to 16)by mean+ SD (7.254+2.88).
Conclusion:Depression is associated with a deficiency in the cognitive state, with familial partner risk being an influential factor that may be preventable. Depression constitutes a health problem among Saudi geriatrics in in Makkah Al-Mukarramah, especially among elderly, those having history of chronic diseases and those having sensory impairment. These results provide insight for all health care workers caring for the elderly, researchers in the field of Geriatrics, and health educators into the particular care needs of elderly patients in Makkah, KSA.

Background:Domestic violence (DV) is both a public health concern and a deprivation of a basic human right in Saudi Arabia.DV has a variety of short- and long-term physical and mental health repercussions
Objectives:To study the prevalence and types of domestic violence in Makkah.
Methods:A community-basedstudy among different age groups from 1 year to older than 20 years.The data were collected from health care facilities during the time from January 2019 – June 2019.
Results:The prevalence of domestic violence in Makkah was high specially among kids, younger ages groups and women. The majority of aggressors were known and reported by mothers more than any other family members. The most common types of violence were physical abuse (33.6%) followed by sexual (23.7%) and multiple types (20.6%) then neglecting abuse (17.6%). The types of violence were correlated with younger age and the mother being the reporter for abuse.
Conclusion: The prevalence of domestic abuse during the study period was high specially among children and women. Further studies should be conducted to assess the prevalence of DV around KSA.

Background:
Primary health care, the basis of universal health coverage, needs to be assessed on its performance through Saudi health care quality system and future opportunities to serve the Saudi Arabian population increase the chance of desired health outcomes. Saudi Arabia has invested heavily in its health care system by establishing health care infrastructures to improve health of the nation. However, it remains to be seen whether it is efficient and effective in providing health care services needed. In spite of substantial improvements in the Saudi Arabian health services sector in the past few decades, the country is facing a number of challenges in its primary health care system. These challenges include increased demand because of rapid population growth, high costs of health care services, inequitable access, concerns about the quality and safety of care, a growing burden of chronic diseases, a less than effective electronic health system, poor cooperation and coordination between other sectors of care, and a highly centralized structure.
Aim of the study: This study aims to determine the impact of quality on the Saudi Heath care system in primary health care centers in Makkah on satisfaction of Saudi people.
 Method:A cross-sectional studydesign. The current study was conducted male and female in primary health care centers in Makkah.the study randomly sampled. The total sample size will be (300) participated. female and male.
Results:Regarding Patient satisfaction about study results showed that the majority of participants were high satisfaction proportions (65.7%) while average satisfaction were (31%) While The Range (50 – 113) Mean +SD (89.913±11.636). Regarding Patients satisfaction about Patients satisfaction about social and behavioral characteristics results show that the majority of participants were high satisfaction proportions (64.3%) while average satisfaction were (33.3%) While the Range (28 –56)Mean+SD(46.796±5.9636)
Conclusion:The Saudi Arabian health care system needs comprehensive reform with a focus on primary health care.There is substantial variation in the quality of Saudi primary care services. In order to improve quality, there is a need to improve the management and organization of primary care services. Professional development 
strategies are also needed to improve the knowledge and skills of staff.
 
 

Background:
Dengue has emerged as a major public health problem, with increasing incidence and widening geographic spread over recent years. It is a vector-borne disease that is transmitted from person to person by mosquitoes. Dengue is a mosquito-borne infection found in tropical and subtropical regions around the world. In recent years, transmission has increased predominantly in urban and semi urban areas and has become a major international public health concern.Since 1994, Makkah province became a dengue-endemic area with high rate of dengue infection during, spring and early summer. The primary-care physician plays a key role in dengue diagnosis, management, and prevention.
Aim of the study:The study aimed to assess the level of knowledge about symptoms of the dengue fever in the primary health-care medical practitioner’s in Makkah Al-Mokarramah city at Saudi Arabia
.Methods: Across sectional descriptive study conducted among including medical practitioner’s  in selected primary health–care centers in Makkah Al-Mokarramah city, during the October to December, 2018, the Sample size of medical practitioners . Our total participants were (300)
.Results: This table shows the majority of participant (43.0%) have average level of knowledge about symptoms of dengue fever followed by (36.3%) of participant high while Range(0-10) and Mean ±SD(6.387±2.323). Regarding knowledge about signs dengue fever, that majority of participant (48.3%) have average level of knowledge followed by (38.3%) of participant have an high level of knowledge while Range(1-11) and Mean ±SD(7.877±2.052). Regarding the participant total level of knowledge about dengue fever, about (41.4%) have average level followed by (38.3%) have average level of knowledge while Range(3-21) and Mean±SD(14.263±4.021)
Conclusion: This review highlights the need for revealed major gaps on knowledge about symptoms of the dengue fever in the primary health-care medical practitioner’s related to dengue Makkah. primary health-care medical practitioner’s working in primary Health care need training and regular supervision to improve their knowledge on the about symptoms of the dengue fever. The results of this study provide a useful opportunity to identify strengths and areas in need of improved, knowledge about symptoms of the dengue fever in primary-care management of dengue.

Hypothyroidism, also known as subclinical hypothyroidism, occurs among 4 to 21 percent of females and 3 to 16 percent of males [1]. Substitution of thyroid hormone with levothyroxine is the therapeutic option for this common illness [2]. The determination of the recommended normal range of thyroid hormone levels is still a point of contention [3]. Furthermore, even if euthyroidism is restored, individuals getting this medication have reported lower levels of happiness[4].

Wet cupping is a traditional and alternative treatment that is still used to reduce patients’ pain in several Eastern and European countries. It has been proven effective and has an essential role in reducing pain and as a treatment for many diseases in past studies. Nowadays, there is a growing interest in the field of complementary and alternative medicine (CAM). This discipline includes a diverse set of approaches used for prevention and treatment of many diseases. Several benefits of CAM have been proven, and it may be considered an effective modality for disease prevention, treatment of non-communicable diseases and for improving the quality of life of individuals with chronic medical conditions.2 Many patients who may not be satisfied with the outcomes of modern medicine, particularly those with chronic diseases, may be satisfied with the outcomes of CAM. Pain is the most common reason for seeking therapeutic alternatives of conventional medicine. Cupping, wet or dry, is an ancient treatment, which was broadly utilized in several communities, and it was recommended by the Islamic society.
Aim of the study: The study aimed to assess the effect of wet cupping use among patients complaining of pain attended in the Hijama clinic in Makkah City at Saudi Arabia.
Method: A retrospective records review study was conducted using medical records of patients who attended in the Hijama clinic at Makkah, KSA from January 2019 to December 2019. Our total, 200 patients attended the clinic during the year 2019. Out of those patients, 120 were complaining of pain and were included in the study. The Chi-square test and Multivariate logistic regression were used to measure the association between the various socio-determinants and the wet cupping use.
 Results: A chi-square test of independence was performed to determine the association between the frequency of WCT use and the main complaint, independence was performed to determine the association between the frequency of WCT use and the main complaint. There was a statistically significant association between them, Chi-square X² =86.663, p=0.001.
 Conclusion: Wet cupping has positive effects on reducing pain. There are promising effects in favor of using wet cupping for improving quality of life of patients with chronic conditions, cupping is recommended as a complementary treatment modality for chronic medical conditions, especially pain .

Background:
Little is known about the implementation of the patient bill of rights (PBR) in Saudi Arabia. In Saudi Arabia, the basic law of governance states that “the State shall look after public health and provide health care for every citizen.” Accordingly, in 2001, the Ministry of Health (MOH) established the General Directorate of Patients' Relation to look after patients' rights and in 2006 was able to publish the first edition of patients' bill of rights (PBR) in Saudi Arabia, which was endorsed in 2010 by the National Society for Human Rights in Saudi Arabia. On November , 2011, the International Conference on Patients' Rights was organized in Saudi Arabia. On December , 2011, a new edition of PBR was published. This was presented at the National Conference on Patients' Rights in Saudi Arabia organized by the MOH on April , 2012.The social system in Saudi Arabia is very supportive for patients and their families and in most hospitals patients have access to free health care services. Professionals, including future physicians are expected to respect patients’ rights, but if they are not familiar with the contents of the bills of rights.
 Aim of the study:To assess the knowledge of the Importance of Patients’ Rights in from the Perspective of senior medical students in Umm Al-Qura University in Makkah Al-Mokarramah city at Saudi Arabia.
 Methods: a cross-sectional study design descriptive study conducted was conducted at College of Medicine, Umm Al-Qura University in Makkah, the study was conducted at sixth and fifth academic level (male and female sections)Our total participants were (400).
Results:shows that the majority of participant approximately (40.0%) were aged <35  years, while data Range (23-59) Mean ±SD (41.112±6.258), gender that male students represent (62.0%) of the participants also that of the(54.75%) participants have average knowledge of the patients’ rights knowledge , (42.5%) have high knowledge of the patients’ rights knowledge, and the data ranged from(8to30)by mean+ SD (21.661+3.879),the X²(177.365) and a statistically significant level, p=0.001
Conclusion: Incorporating patient priorities and preferences into their healthcare can improve desirable proximal outcomes related to communication such as the patient feeling heard, understood, respected and engaged in their care. Knowledge of the senior medical students regarding patients` rights is generally acceptable.

  Background
       The Kingdom of Saudi Arabia (KSA) annually hosts more than three million Muslim pilgrims from around 184 countries during the Hajj pilgrimage. Respiratory tract infection (RTI) is a major public health challenge during the Muslim pilgrimage to Makkah. It is necessary to take health precautions among these pilgrims the uptake of health preventive measures among Hajj pilgrims from Saudi Arabia, bacteremia, otitis media, and bacterial meningitis, in addition to a significant cause of sinusitis, osteomyelitis, septic arthritis, endocarditis, and peritonitis. Complications of each of these diagnoses are common. Pneumonia is one of the leading causes of hospitalization and intensive care unit among pilgrims in Saudi hospitals during Hajj. During the 1986 Hajj season, pneumonia was the second most common cause of hospitalization with the highest case fatality ratio among those aged over 50 years, therefore pneumococcal vaccination is recommended. Clinical symptoms, signs and physical examination findings alone cannot differentiate pneumonia disease from infections caused by other pathogens,to our knowledge there is no study that has explored the knowledge, attitude, and practices related to pneumococcal infection and vaccination among all Hajj pilgrims in KSA.
Aim of the study:To assessment of awareness and Attitude toward Prevention of Pneumococcal Infection and vaccination among Hajj and Umrah Pilgrims from Makkah in 2018
.Methods:Methods: Across sectional descriptive study conducted among pilgrims who resident in Makkah city during May 25, 2018 to 24 October 2018  Hajj 2018,  Our total Sample size of pilgrims participants were (500)
Results: the majority of participants (67.0%) have a weak knowledge while Range (1-21) Mean± SD (8.155±3.011). While more than half of them (61.0%) have a positive attitude about the disease, while Range (0-8) Mean± SD (3.944±1.098
)Conclusion:Before Hajj doctors must teach and inform all the participants about how to deal with any infectious disease, particularly pneumonia.Significant opportunities for improving Knowledge and awareness among Hajj pilgrims about the importance of using preventive health measures. Moreover, emphasizes the need for better communication between official health authorities in Saudi Arabia and all Hajj pilgrims regarding Hajj health information.

With the growing interest in conducting multi- centre and multi-modality studies on
neurological disorders, post-reconstruction PET image enhancement methods that take advantage
of available anatomical information are becoming more important. In this work, a novel method
for denoising PET images using the subject’s registered T1-weighted MR image is proposed. The
proposed method combines the non-local means approach with the twicing strategy from the image
denoising literature to restore a reconstructed PET image. Preliminary analysis shows promising
improvements in peak signal to noise ratio (PSNR) and contrast recovery coefficients (CRC) of the
lesions when denoising simulated images reconstructed using the MLEM algorithm.

Background:
Primary health care physicians manage most patients with osteoarthritis. Osteoarthritis (OA) is one of the leading causes of disability. The prevalence of OA is expected to increase because of ageing and obesity, and health care professionals must prepare for a rise in the demand for OA care. Osteoarthritis (OA) is the most common form of arthritis and the leading source of physical disability in elderly people. The Prevalence of OA is increasing and will continue to do so as the population gets older. The OA is predominantly managed in primary care centers by primary health care physicians and much can be done to alleviate symptoms from osteoarthritis by combinations of therapeutic options including pharmacological and non-pharmacological treatments, in the Kingdom of Saudi Arabia. The diagnosis is made by history, typical x-ray findings and non-contributory laboratory investigations. The understanding of the pathogenesis of the condition is undergoing change. The development of osteoarthritis is dependent on age, sex, genetic predisposition, and previous trauma to the joint and abnormal mechanical forces caused primarily by obesity.
Aim of the study:To  assess the level of knowledge of Osteoarthritis Management among Primary Health Care Physicians at Primary Health CareCenters of Ministry of Health.
Methods:Cross-sectional study was done, including a representative random sample of PHC physicians working at PHC centers of MOH in Makkah city. during the October to December, 2019, the Sample size of physicians working at PHC centers . Our total participants were (150)
.Results:the majority of participant (44.0%) have weak level of total knowledge about Osteoarthritis Management followed by (35.0%) of participant average while Range(2-8) and Mean ±SD(5.15±2.877) and also shows that is a statistical significant were Chi-square 12.52and P=0.0019
Conclusion:Conduct Saudi guidelines and further studies to assess the practice of PHC physicians regarding osteoarthritis, is recommended. Overall knowledge of PHC physicians in Makkah city regarding OA is acceptable; despite being deficient in some important issues.  Finally, when the conservative management by the primary care physician is of benefit no longer, judicious referral to an experienced Orthopedic Surgeon for the modern surgical approaches should be

Background:
Adequate nutrition is essential for maintaining health and well-being. Apart from nutrition intake through diet, supplement use is prevalent worldwide, supplements are commonly used to replenish the body with essential nutrients that are important in regulating the body’s metabolic processes, The use of supplements, which may be defined as multi-vitamins, single vitamins, single minerals, herbal supplements, oil supplements and any other dietary supplementation, the economic boom in Saudi Arabia indirectly, prompted the use of dietary supplements in the last two decades. Must to investigate the prevalence of dietary supplement use and its association with socio demographic. The Kingdom of Saudi Arabia is a fast growing economic country that has affected its general population in various ways including a transition in daily lifestyle patterns and dietary intake habits.
Aim of thestudy: to Assessment of the prevalence of Using Dietary Supplements Among Physically Active Adults in Makkah ALMukarramah 2019.
 Method:Cross-sectional study design. The current study was conducted at   Sports and Physiotherapy Center and fitness time centers at Holy Capital of Makkah, during the October to December, 2019,Our total participants were (400).
 Results: that a significant difference between age and using supplements in the study while Chi-square 24.413& p-value= 0.001. Most age of participants use supplements from 23-35years were constitute (30.0 %), the gender that no significant difference between using supplements and gender in the study while Chi-square 1.437& p-value 0.911 less than 0.05 , regarding education show that significant difference between education status and using supplements in the study while Chi-square 14.827& p-value more than P=0.022.
.Conclusion: Supplements were commonly used among female students, The prevalence of dietary supplement use was high and was significantly associated with socio demographic and lifestyle factors.A substantial proportion of populations take supplements. Further investigation into the social, psychological and economic determinants that motivate the use of supplements is required, to ensure appropriate use of supplements among adults and the most commonly used supplements.

HT is among the leading causes of mortality globally, impacting all economic classes in all nations[1, 2]. As per international health records from 2012, it affects 29.2 percent of males and 24.8 percent of females[1]. Furthermore, in 2004, HT was associated with 7.5 million fatalities out of 58.8 million deaths worldwide, making it a leading cause of early deaths in the world[3].
HT levels are extremely increased in Saudi Arabia (SA), where it was documented between 1995 and 2000 to vary from 26.1 percent among the 30–70 year old population, and in 2005 to range from 25.5 percent among the 15–64 year old age group[4, 5]. According to 2010 estimations, HT was classified as the leading cause of death in South Africa[6]. Patients with unmanaged HT can provide a significant burden to the healthcare system, necessitating the development of additional remedies to reduce the potential liability of HT in South Africa[4].
Hypertension is a prominent area of attention since it is a common illness that may be controlled with both nonpharmacological lifestyle variables and therapeutic interventions. Although antihypertensive drugs have been used to manage blood pressure, there is a significant focus on the treatment and prevention of Hypertension using non - pharmacologic approaches referred to as lifestyle changes [7-9]. Salt limitation, reduction of alcohol intake, high intake of fruits and vegetables, low-fat, weight loss and management, and regular physical activity are among the suggested lifestyle modifications that were demonstrated to reduce blood pressure. Patients with hypertension, regardless of stage or severity, should be encouraged to take these precautions. Empowering patients to make lifestyle adjustments is among the most difficult parts of Hypertension management [10].
Knowledge is a corner stone in the management of hypertension along with positive attitude and good practice[11, 12] thus this study is assessing the level of knowledge, attitude and practice of hypertensive patients toward hypertension.

Background
Smoking is now well established as a recognized cause of cancer, lung disease, coronary heart disease, and stroke; it is considered the single most important avoidable cause of premature morbidity and mortality in the world. Additionally, epidemiological studies have reported positive associations between smoking and psychiatric disorders. Several studies have found high rates of smoking among selected populations of persons with mental illness, whereas general population surveys have demonstrated a significant association between current smoking and psychiatric symptoms.
     The World Health Organization has reported that more than 4 million annual deaths are attributed to tobacco consumption; this is projected to be10 million annually in 2030. Conversely, smoking cessation reduces health risks and improves quality of life. In particular, the cumulative risk of dying of cancer, cardiovascular and lung diseases can be drastically reduced if smokers quit, even at an advanced age.Objective: To assessment the health-related quality of life (HRQL) among Patients Smoking attitudes attending smoking clinics Primary Health Care Centers in Makkah. Aim of the study Aim of the study: The study aimed at assessing the health related quality of life among Patients smoking attitudes attending smoking clinics Primary Health Care Centers in Makkah. Method: A cross-sectional descriptive stud conducted from January, 2019 to December, 2019 in four Primary Healthcare Centers (PHC)in Makkah, the Sample size of Patients Smoking Attitudes attending PHC. Our total participants were (80). Results: the specific medical diseases significantly associated with smoking were Musculoskeletal disorders and  Central nervous system diseases  were (P < 0.001 and=0.033 ) and X2 25.481and 3.554 with the Negative in age (25-35) of the patients was (66.67% and 11.11% ) while in Positive age patients was (33.33% and 83.33%) while all anther medical diseases no significantly associated with smoking .Conclusion . the health related quality of life among Patients smoking attitudes  attending Primary Health Care Centers in Makkah smokers with smoking history show significant impairment in the physical and mental domains of HRQL in comparison to never-smokers. Postgraduate studies, workshops and training are indeed necessary to help PHCPs' to understand the significance of the role they play in implementing SCC for patients, individuals, family and the community effectively.

The patient right is described as the code of behavior that governs interactions between individuals who receive health services and the organizations that provide them, and is owed by the patient to both the practitioner and the government. The status and preservation of this right as they pertain to the nursing profession[1, 2].
Health care professionals such as physicians, health assistants, and most importantly nurses are constantly in contact with patients, since nurses stay with the patient at all times to give care. To ensure the highest quality of care, healthcare nurses need not only be knowledgeable about illness but also aware of human rights violations and patient maltreatment that may occur in the hospital while delivering care[3, 4].
Numerous facets of the interactions between midwives or nursing staff and patients were scrutinized in a manner similar to that of physicians and patients[5, 6]. Medical technological advancements have the potential to have a major effect on patient rights[7, 8]. Global events that have impacted social, financial, cultural, geopolitical, and moral issues have also impacted our perception of what "human rights" are. Yet, the basic reason for the increased emphasis on patients' rights and the resulting growth in legislation is because protecting patients' rights is a necessary component of delivering quality health care[9, 10]thus this study is determined forevaluating the level of knowledge and attitude of nurses towards patient rights.

Background:
      Diabetes mellitus and obesity are key risk factors for long-term complications associated with type 2 diabetes mellitus. Previous studies have shown that the prevalence of diabetes mellitus and obesity is high in the KSA. However, none of these studies has focused on the investigation of diabetes mellitus and obesity in Makkah patients with type 2 diabetes mellitus. Obesity and diabetes mellitus are known to contribute directly or indirectly to the development of long-term complications of type 2 diabetes mellitus. Obesity is a serious public health concern all over the world. In KSA obesity is on rise and if proper intervention and preventive strategies were not adopted of obesity will prove fatal. Obesity among type 2 diabetic patients has proven to have adverse effects in management and control of diabetes and a considerable proportion of type 2 diabetic patients have been reported to be obese in different settings, which increase the risk of complications among them.
Aim of the study: To assesment of the prevalence and associated risk factors of obestiy among type II diabetic patients in the primary health care center in Makkah Al-Mukarramah 2019.
Method: A cross-sectional study was conducted at AL-Eskan PHC, among type II diabetic patients and obesity attending in the AL-Eskan PHC Makkah among a random sample of type 2 diabetic and obesity patients registered in the chronic disease clinic. Our total sample size will be 200 patients
. Results:  the majority of our participants were have increase BMI (obese) were constitutes (59.0 %), while normal BMI participants were constitute (40.0 %). the majority of our study are male’s gender in our study was (59.0%). the majority nationality Saudi was (87.0%)
Conclusion: Physical activity probably contains a larger role in promoting health in weighty populations than antecedently thought and should confer substantial reductions in sickness burden. Future analysis might examine prospectively whether or not increase in physical activity in unhealthy weighty adults will cause a healthier standing.

Background
seasonal influenzavaccination is essential for population health. However, despite its strong recommendation, studies indicated a low rate of vaccine response. Influenza is a serious disease that can cause hospitalization, intubation, and death in high-risk groups. Influenza complications are due to changes in the immune, respiratory, and cardiovascular systems. Patients  with an influenza infection are at increased risk of severe illness and complications and have a higher mortality and morbidity rate. Despite the significant role of seasonal influenza vaccination in preventing and minimizing the serious complications of influenza infection in patients, unsatisfactory compliance still exists for vaccination. Vaccination against influenza is the main way to reduce the substantial health burden that seasonal influenza causes, and is the primary tool to prevent influenza infection. The Advisory Committee on Immunization Practices at the US Centers for Disease Control and Prevention (CDC) recommended that all people above age 6 months receive the influenza vaccination annually unless contraindicated
. Aim of the study:To explore knowledge and attitudes of patients attending in Primary Health Care about the seasonal influenza Immunization at  Makkah Al-Mokarramah 2019.
Methods: This cross-sectional study was conducted among 200 participants from  health care centers in Makkah Al-Mokarramah city. A validated self-administered questionnaire was used. It includes questions on sociodemographic variables, knowledge, attitude, and vaccine response. during the September to December 2019.
 Results:the majority of participant (50.5%) have average of the knowledge towards seasonal influenza vaccination followed by (29.0%) of participant high while Range(3-9) and Mean ±SD(6.390±1.781), X²25 P=0.001also shows the majority of participant (50.5%) have average of the knowledge towards seasonal influenza vaccination followed by (29.0%) of participant high while Range(3-9) and Mean ±SD(6.390±1.781), X²25 P=0.001
Conclusion:The study showed poor knowledge and attitude toward seasonal influenza Immunization among patients and general population but a relatively accepted rate of vaccine response. Vaccination response was associated with knowledge, marital status, education, and age. This study recommends implementation of the health educational programs to increase the knowledge to the patients and general population.

. Background
Migraine poses a significant burden for patients, and it has multiple diagnostic and management challenges, particularly among primary health-care workers ( physicians, nurse, administrative). Migraine is a public health problem and it is the third most common cause of disability among individuals below the age of 50. In spite of the multiplicity of the studies concerned with exploring the disease epidemiology and nature worldwide, data from Saudi Arabia are lacking.  Migraine is one of the most critical concerns among healthcare providers and other relevant stakeholders in the health sector. It is one of the significant causes of disability among older patients (aged 50-years and above). Saudi Arabia has had its share of the health issue with the ever-increasing prevalence of migraine in the country. Despite the concerted and collaborative efforts among major stakeholders on the provision of the assessment of the identified health problem, data from Saudi Arabia mostly lack, especially on the epidemiology of the health condition. According to the recent reports from the Global Burden Disease (GBD), migraine ranks third among the leading cause of disability globally. The prevalence rate varies significantly within the Arabian countries; Saudi Arabia (12%), Qatar (72%), and Oman (83%).
 Aim of the study: To assessment the levels of knowledge of the prevalence  Migraine headache among healthcare providers in PHC centers in Makkah City, Saudi Arabia, 201
9 Method:Across-sectional study among healthcare providers who works in primary health care center in Makkah Al-Mukarramah 2019, the study has been conducted healthcare providers who works in PHC centers in Makkah city KSA. Was conducted using questionnaire designed during August 2019. The questionnaire collected the socio-demographic factors, a migraine screen questionnaire (MS-Q) Migraine Disability Assessment questionnaire (MIDAS), our total participants were (200)
Result:Conclusion:Knowledge regarding migraines diagnosis and treatment was inadequate among healthcare providers , which could detrimentally influence the patterns of referral to secondary health-care facilities, severity of symptoms was accompanied by poor quality of life in terms of social and professional aspects. There was a lack of awareness in majority of subjects about migraine leading to underdiagnosed, under treatment and with high use of over the counter medications. There is a need for proper awareness campaigns in Saudi population and also healthcare providers.

Errors in medication administration are among the most underreported medical mistakes, and this raises alarm bells all around the world. "any avoidable incident that might lead to an incorrect pharmaceutical usage that has the potential of causing damage to the patient" can be regarded as a medication mistake [1-6]. Despite the fact that drugs can be beneficial, they can also be harmful if misused. Several causes, including a lack of performance, a lack of information, slips, and lapses, may be to blame for the harm caused by prescription usage. Mistakes in medication administration can have a significant impact on a patient's health care costs and quality of life, as well as on the health care providers who care for them. It's important to improve knowledge about pharmaceutical mistakes and their repercussions in order to decrease them [7, 8].
Medical mistakes can occur at any point in the process of prescribing or administering a patient's medicine at a hospital. In the Kingdom of Saudi Arabia, prescribing mistakes account for roughly one-fifth of all drug errors in primary care settings (KSA) [1, 9-12].  But the percentage of mistakes that occur at each level is variable [13].
Nurses have an important role in the safe administration of medications, which includes, but is not limited to, raising awareness of the risks associated with the possibility for medication mistakes. Patient and medication assessment is carried out by nurses, who utilize their expertise and clinical reasoning to ensure that medicine is administered safely [14].
Numerous hospitals across the world have adopted safety reporting systems (SRS) to document occurrences that may jeopardize patient safety [15]. The system consists of an incident description followed by extensive clinical and patient information. Active learning and better health approaches decrease the rate of unfavorable occurrences, hence eliminating similar errors from occurring in the future. The health care practitioner must understand that drug mistake reporting is not an employer's fault, but rather a systemic failure. When a multidisciplinary approach to healthcare systems is used, errors are rarely the responsibility of a single individual [16]. Despite greater reporting of pharmaceutical mistakes, analysts claim that medication errors remain underreported in practical terms [13, 17, 18]. This study is determined for estimating the level of KAP of nurses towards drug errors reporting.  

Background: despite multiple specialties dealing with UTI management in pediatric age group, level of knowledge is found to be varied among them in western surveys.
 Purpose: to evaluate the knowledge regarding management of urinary tract infection in children among primary health care physicians and to improve quality of our primary health care.
Methodology: The study was conducted in the city of Makkah Al-Mukarramah included all primary health care physicians working in PHCCs in Ministry of Health. The sample size was 129 candidates. A self-administered questionnaire that has been validated in previously published study and admitted in the study. Permission by e-mail was taken to use the questionnaire. It includes three main sections; demographic questions, level of knowledge about diagnosis and finally the level of knowledge about treatment. The researcher visited the selected PHC centers after getting approval from MOH.
Results: weak knowledge about UTI diagnosis and management was recorded in 70% of participants. The score of knowledge was ranging from 4-21 with mean and SD 11.519+3.765. Total knowledge were markedly and statistically significant different in the area of experience, training, courses obtained about UTI and qualification (p values were 0.004, 0.048, 0.002 and 0.003) respectively.
Conclusion: level of knowledge is extremely weak and minute despite variety of specialties and board certified. Whatever the size of pediatric group diseased with UTI, family physician should be aware of the NICE guidelines of treatment.

Background:  Workplace violence (WPV) is a serious worldwide concern, especially for health care professionals when compared with workers in other industries. Violence in the health care sector harms both patients and health care professionals and causes enormous economic losses. Victims of WPV show signs of anxiety, depression, and low efficiency in their work performance, which may decrease the quality of the service that they provide. Among health care professionals, nurses who have direct contact with patients face numerous risks related to WPV. Therefore, it is important to recognize risk factors that can be used to reduce the incidence of WPV against nurses. Emergency healthcare workers (HCWs) have a high risk of exposure to violence with negative personal consequences. Violence is an occupational hazard in hospitals. Occupational researches have gradually shifted focus from traditional, visible environmental risk factors, such as physical, chemical, biological exposure or ergonomic problems, to the invisible, psychological harm that maybe present in the workplace.
Aim of the study: To assessment of Prevalence  of Workplace Violence among  and Nurses and Physicians at Emergency Department in  Primary Health Care Centers and confirm the factors influencing such violence.
Method: Cross-sectional analytical study has been conducted at emergency departments (EDs), Primary Health Care Centers in
Makkah city, during data collection period 2019, the total sample has been (400) nurses and physicians.
Results: Regarding the age the highest age were (35.0%) were (30-40) years and the data ranged from (22-57) by mean ±SD (38.315±9.816), were females (57.0%)while males. The majority of the participated nurse were(67.0%), followed by doctor were(33.0%). Regarding the qualification, the majority of participated heave Bachelor were (28.0%) followed by Resident (21.0%), the participated experience in from 6-10 years were (31. 0%).More than half of the participants were yes to physical or verbal violence and their percentage was (75. 0%).Conclusion: Workplace violence was prevalent, and verbal abuse was the commonest type among HCWs in emergency departments of PHC.  Workplace violence, a possible cause of job stress, has recently become an important concern in occupational health. Almost half of the ED nurses and physicians experienced one or more WPV incident.

Background
Obesity is emerging as a serious problem throughout the world, not only among adults, but also health care worker and children, teenagers and young adults. Of the factors contributing to obesity, stress seems to be particularly important as stressful condition leads to irregularity in worker in work, lack of exercise and addiction also considered independent and factors leading to stress. Workers in the health care is stressful throughout the whole work time. The amount of material to be absorbed, social isolation, pressure of examination, discrepancies between expectation and reality all can be anticipated to bring psychological stress. Prevalence of Stress and its Association with Body Weight Among health care worker,
Prevalence of stress and its Association with Body Weight Among health care worker fears related to stress have affected a considerable number of health care worker, especially the nursing category,studies have shown that healthcare workers managing patients have been experiencing worse psychological issues such as stress than the public because they are more likely to get infected and transmit the infection to their relatives and friends.
Aim of the study: To assessment of the prevalence of stress and its association with Body Weight Among health care workerin Primary Health Care Centers in makkah 2019
Method:Cross-sectional analytical study has been conducted health care workers at Primary Health Care Centers in Makkah city, that included all health care worker during data collection period 2019 the perceived stress scale-10 questionnaire used to measure the stress score. Weight and height were collected based on self-reported value.  the total sample has been (400) nurses, physicians and other
Result:the majority of the respondents were married status were (75.0%) while other were (14.0%).  The association between the stress and stress score most of the participant moderate Stress were constitutes (47.75%) followed by low stress the were constitutes (44.75%) while a statistically significant (P-value =0.001) and Chi-square (120.665), the Range (5-45) (Mean ± SD (25.441±6.125).
 Conclusion:Stress is prevalent among health care worker at Primary Health Care Centers, Makkah we found a positive correlation between BMI and stress but no statistically significant association between gender and stress level. Preventive measures should be implanted to reduce the level of stress and interventional studies are needed among health care worker at Primary Health Care Centers.

Background:
The compliance with standards in health services is non-negotiable as it is fundamental in improving KSA current poor health outcomes, restoring patient and staff confidence in the public healthcare system, achieving widespread sustainable development and providing basic quality healthcare in KSA. Despite the growing interest in understanding the a etiology of chronic diseases, limited studies exist on medication noncompliance, especially, among perturbing and rural dwellers in KSA. Barriers to medication adherence in patients can have significant differences that made researchers confute to conclude that medication adherence is required to be more explored, and then, beneficial interventions develop to decrease these barriers. Some of the main barriers to patient compliance with pharmacological therapy The barriers to medication adherence included four concepts, namely, lifestyle challenges, patient incompatibility, forgetting of medicine use, and no expert advice. These concepts are always present in the disease process and reduce the patients' efforts to achieve normal living and adhere to the medication. Medication non-adherence when patients don’t take their medications as prescribed is unfortunately fairly common, especially among patients with chronic disease.Most non-adherence is intentional patients make a rational decision not to take their medicine based on their knowledge, experience and beliefs There are many reasons for non-compliance with in patients for medication.
Aim of the study: To assessment of drug noncompliance among patients who are attending out patient's clinics in Primary Health Care Centers, Makkah, 2019 at Makkah Al-Mokarramah.
 Method:Across sectional descriptive study conducted among including Sample population consists of Saudi out patients aged 20-60 years attending to outpatient in selected primary health–care centers in Makkah Al-Mokarramah city, during the October to December, 2019, the Sample size of medical practitioners. Our total participants were (234).
Results:shows a statistically significant association socio-demographic (age, education, occupation, income) and Regular taking medication with (P-value <0.001) , respectively Chi-square (34.607, 72.638, 9.144, 32.151) Regarding gender shows no statistically significant association between gender and Regular taking medication with (P-value 0.364) , Chi-square (0.826).
 Conclusion: Recommendations to facilitate compliance with were described, which included implementation of effective management practices and allocation of adequate healthcare resources required to facilitate such compliance. ​The factors related to compliance may be better categorized as factors as the approach in countering their effects may differ. The study also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes. Drug noncompliance not only includes patient compliance with medication but a lot of factors For example also with diet, exercise, or life style changes

Background                                     
Developmental milestones are a collection of objectives or indicators that a child is supposed to perform during development period. These are classified as gross motor, fine motor, verbal, cognitive, social-emotional, and behavioral. Monitoring and recognizing developmental milestones can assist providers in diagnosing delayed development more accurately, allowing for early intervention and improved results[1].
The term "developmental delay (DD)" refers to a delay in attaining baseline milestones in the 5 developmental domains[2]. Early DD is associated with poor attention and behavioral issues in infants and low academic performance in school-aged children, with future mental, emotional, social, and economical implications as these children mature into adolescence [3].
Additionally, researches have proven that good parenting is contingent on mothers' knowledge of child development, as mothers who understand how to promote their children's growth will have more favorable results [4]. On the other hand, insufficient understanding results in erroneous expectations and an overestimation of the rate of growth, frequently manifesting as impatience or intolerance toward the child's behavior [5, 6].
Parents often desire to participate in assessing and supervising their child's growth [7], and they get varying degrees of information and instruction in order to fulfill this role. While it is obvious that parents have a patchwork understanding of children development, little is known about their degree of knowledge and the factors that impact it[8].
The types of information that parents have access to and the reliability of the sources remain unknown. 'There is conflicting data in the literature about parental understanding of child development' [9]. Additionally, there have been no local research on this issue in Saudi Arabia to far, indicating that this study will fill a critical need.This study is determined forevaluating the level of knowledgeof motherstowards developmental milestones.
 

Background:
      Influenza is a seasonal epidemic with main symptoms that include fever, cough and muscle aches. Fever is a big distinguishing component between a cold and influenza. Some other common symptoms which may or may not be seen with a cold as well are headache, chills, loss of appetite, fatigue and sore throat. diabetes, influenza is a significant burden on the healthcare systems. A significant issue and a significant big health concern happen every year is looking how we could mitigate and manage it and obviously take the burden off the health care system. Diabetic patients, as other chronic diseases patients, could catch the influenza infection, which is a respiratory infection caused primarily by influenza A and Influenza B. Diabetes Mellitus (DM) is a major health problem worldwide. It is a number of metabolic disturbances that is characterized and identified by the presence of hyperglycemia in the absence of treatment.
Aim of the study: to assessment of the Prevalence of Influenza Immunization among Diabetic Patients attending Primary Health Care Center In Makkah Al-Mokarramah,2019.
 Methods: A Cross-sectional analytical study was carried out in the city of Makkah among diabetic patients attending  Primary Health Care Center during  the October to December 2019, the Sample size patients participants.  Our total participants were (300).
Results: shows the majority of participant (39.5%) have average level of total attitude of diabetic patients towards seasonal influenza vaccination followed by (29.5%) of participant weak while Range(7-19) and Mean ±SD(13.065±3.822), X²11.59 P=0.003.Conclusion: Undermining the effect of influenza and misconceptions on the effectiveness of the vaccine could much be improved by increasing awareness and knowledge, seasonal vaccination among diabetics in KSA is low. Level of knowledge and perception are the main barriers to vaccination. Health care provider’s advice may be an important key predictor of previous influenza vaccination and they should continue to educate and encourage all diabetics to get vaccinated for influenza at least once yearly.

Background:Asthma, the most common chronic illness in children is responsible for more school absenteeism than any other single chronic childhood condition. Acute asthma attacks while at school can cause considerable disruption to scheduled school activities, broadening its impact on school participation. Children with asthma face multiple challenges that encompass learning how to cope with. Bronchial asthma (BA) is a public health problem in all countries irrespective of their level of development, being generally under-diagnosed and undertreated, and most asthma-related death commonly occurs in low-income and lower-middle income countries. As for Saudi Arabia, it is estimated that more than 2 million Saudis have asthma, and the percentages range from 8% to 25% in Saudi children. In 2004, the highest prevalence of asthma was reported by physicians in Saudi Arabia (25%). Bronchial asthma is a serious disease since it is very common disease in Saudi Arabia, and it doesn’t only affect the individual physiologically, however it also affects the individual’s quality of life, leading to missing days from school or work, emergency hospital visits, hospitalization, and caregivers and parents’ time and effort. Consecutively, it affects the whole community.
Aim of the study:To assessment the knowledge of the regarding childhood asthma at Makah city in Saudi Arabia. 2019.
Method:A cross-sectional study was conducted   attending the primary health care centers in Makkah, Saudi Arabia. An asthma knowledge questionnaire was used to measure the knowledge. during the April to June, 2019, participants were (800).
Results: Regarding awareness of the participant toward asthma study results show the majority of participant had average information were(59.0%) while weak awareness were(22.0%) the data ranged from(6-28) by mean ±SD(16.577±5.87).
Conclusion:The bronchial asthma knowledge in the Saudi Arabian population is insufficient, and efforts should be carried out to spread asthma knowledge to the people. Bronchial asthma management should include patients, parents, and public awareness regarding the disease, its symptoms, medications.

Background
Children with asthma face multiple challenges that encompass learning how to cope with. Bronchial asthma is a public health problem in all countries irrespective of their level of development, being generally under-diagnosed and undertreated, and most asthma-related death commonly occurs in low-income and lower-middle income countries. Family management of asthmatic children is affected by several factors, primarily the parent’s knowledge and attitude toward asthma. In 2004, the highest prevalence of asthma was reported by physicians in Saudi Arabia (25%). Bronchial asthma is a serious disease since it is very common disease in Saudi Arabia, and it doesn’t only affect the individual physiologically, however it also affects the individual’s quality of life, leading to missing days from school or work, emergency hospital visits, hospitalization, and caregivers and parents’ time and effort. Consecutively, it affects the whole community, asthma, the most common chronic illness in children is responsible for more school absenteeism than any other single chronic childhood condition. Aim of the study: To assessment the level of Knowledge of parents about asthma in their children at MakahMethod: A cross-sectional study was conducted   attending the primary health care centers in Makkah, Saudi Arabia. An asthma Knowledge of parents about childhood asthmawas used to measure the knowledge. During the October toNovember, 2019, participants were (200).
Results:Knowledge of the participant toward asthma study results show the majority of participant had average information Myths and beliefs regarding asthma were(65.0%) while Range (9-18) Mean± SD(12.144±4.15), regarding the General knowledge about asthmashow the majority of participant had average information were(51.0%) while Range (4-15) Mean± SD(11.58±3.15), also Knowledge about associated aspects of asthmathe majority of participant had average information were(78.0%) while Range (5-10) Mean± SD (7.108±2.011).
Conclusion:The asthma knowledge in the Saudi Arabian population is insufficient, and efforts should be carried out to spread asthma knowledge to the people among the parents and guardians of asthmatic children. asthma management should include patients, parents, and public awareness regarding the disease, its symptoms, medications, and highlight the misconceptions about asthma medications at both hospital level and community, for better control of asthma, more effort is needed to educate caregivers and to enhance them.

background: Most health care providers are aware of e-cigarettes, but the information is scarce regarding the magnitude of this newly emerged habit in Saudi Arabia, since introduction in the early 2000s, e-cigarette use has rapidly increased among adolescents worldwide. then adult  However, little is known about e-cigarette uptake among adolescents in Saudi Arabia. Tobacco smoking is highly prevalent in Saudi Arabia, and there is a need to reduce the resultant health burden via patient-oriented smoking cessation interventions. Primary care physicians (PCPs) have a significant role in providing counseling and advice to quit smoking.
World Health Organization (WHO) reported tobacco use as one of the biggest public health threats the world has ever faced. WHO report on the global tobacco epidemic, mentioned that in 2015, over one billion people smoked tobacco. This study aimed to assess Prevalence of Electronic Cigarettes Use Among health care providers in the Primary Health Care in Makkah, Although it is declining worldwide in many countries, the prevalence of tobacco smoking appears to be increasing in the Eastern Mediterranean Region
.Aim of the study
This study aimed to assess Prevalence of Electronic Cigarettes Use Among health care providers in the Primary Health Care in Makkah 2019.
methods:Cross-sectional descriptive study was carried out, including a random representative sample of health care providersin the Primary Health Care in Makkah.A self-administered validated questionnaire was adopted and modified. The Sample size of medical practitioners . Our total participants were (500)
Results: showed that the majority of the participant were (52.0%) smoker regarding smoking period the majority while <5 were (35.0%), Current use of e-cigarettes were(72.0%) and (30.0%) of the participant knew that the electronic cigarettes contain nicotine whereas 56.15% did not know if e-cigarettes contain nicotine or not. Most of the students (75.0%) thought that the electronic cigarette is harmful to health.
Conclusion:The prevalence of e-cigarettes smoking among health care providers in the Primary Health Care in Makkah. was found relatively high and most common reasons to smoke e-cigarettes were similar taste to conventional cigarettes, adequate nicotine, helping in control of smoking behavior, perceived less harmful effects than conventional cigarettes, and low cost. E-cigarettes have been tried and currently used by a considerable proportion of health care providers. Some associated factors were identified.

Background: Lower urinary tract symptoms and urinary incontinence are very common in the general population and increase in prevalence in association with age. Urinary incontinence in particular is still seldom discussed by patients, many of whom delay seeking healthcare for the condition. Urinary symptoms have a considerable impact on morbidity and quality of life. Older people encounter multiple barriers in gaining treatment for their problem and are unfortunately less likely to be given evidence-based treatment than younger people. Urinary incontinence means a person leaks urine by accident. While it may happen to anyone, urinary incontinence is more common in older people, especially women. Incontinence can often be cured or controlled. The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don’t work the way they should, urine can leak. Incontinence typically occurs if the muscles relax without warning.
Aim of the study: This study aims to assessment the prevalence of urinary incontinence among elderly patients attending the primary health care centers in Makkah Al-Mukarramah, KSA.
 Method: A cross-sectional study will be conducted to estimate the prevalence of self-reported UI among elderly patients attending primary health care centers in Makkah Al-Mukarramah in date collection period. Our total of simple is (400) elderly patients
Results : A total of is (400) elderly patients .The majority of the respondents were females (57.14% ), Malays (42.86 %), The age of the respondents ranged from 25-65 years, with a mean of 37.87±12.088 years showed positive correlations between degree of symptoms and signs of diagnosis of incontinence and degree the Frequency of symptoms Where (r = 0.578) and have statistical  a significant relation where p < 0.001).
 Conclusion:Urinary incontinence is common and often disturbing Saudi elderly, our study found that the prevalence was it adversely impaired their quality of life (QOL). Elderly age and parity were significantly related to impaired QOL. We acknowledge the fact that urinary incontinence is a common and poorly understood problem in our community.  Another problem in the elderly age group is cognitive impairment, which also contributes to urinary incontinence. Prevalence of urinary incontinence is most likely underestimated.

Background: Epilepsy is the most prevalent neurological condition and is one of the most prevalent non-infectious diseases in the world. It has been reported that epilepsy is the commonest disorder encountered in most pediatric neurology clinics in the developing world.Epilepsy is a neurological disease characterized by two or more unprovoked seizures. It is an abnormal electrical firing of neurons. The morbid fear of having an unpredictable seizure not only affects the patients' physical function, but also emotional well-being, cognitive function, and social function, Epilepsy is a category of progressive and complicated neurological diseases characterized by epileptic seizures of an intermittent and crippling nature . It is the most prevalent non-infectious, neurological condition in the world. It has been reported that epilepsy is encountered in most pediatric neurology clinics, especially in the developing world. It is characterized by various neurological abnormalities, one of them is epilepsy. Epilepsy is difficult to control, as it is able to aggravate motor disorders and disrupt cognitive function, ultimately worsening the long-term outcome.
 Aim of the study: To Assessment of the traits of Epilepsy in Cerebral Palsy Children in the in the outpatient neurology clinics in Makkah, at Saudi Arabia 2019.
 Method:A cross-sectional study has be conducted using snowball sampling strategy. A self-administered questionnaire was designed and will be sending to the study participants through social media platforms and email. Study participants will be recruited across in the outpatient neurology clinics in Makkah in Saudi Arabia about awareness of the epilepsy in Cerebral Palsy Children and association with socioeconomic status in KSA. Our total participants were (120).
Results: In our study showed that the only (44.00%)of the participated were(25-35)years while (33.00%)were(<25)years, regarding the Education the majority of the participated school were (47.50%), the majority of the participant were Saudi  (65.00%) while non-Saudi were(35.00%) . The majority of the participated the family monthly income < 5000 SAR were (68.33%), followed by 5000 to 10000 SAR were(16.00%). 
Conclusion:the geographic variables were significantly associated with the risk of epilepsy in children with CP. Patients with epileptic CP had a higher odds ratio of several neuropsychiatric diseases, including mental retardation, ophthalmologic problems, hearing impairment, and hydrocephalus.

Our research Paper” Smart Agriculture System Using IoT” is an in spite of the discernment individuals might have in regards to the horticultural interaction, actually the present farming industry is information focused, exact, and more brilliant than any time in recent memory. The fast rise of the Internet-of-Things (IoT) based innovations updated pretty much every industry including ―smart agriculture‖ which moved the business from measurable to quantitative methodologies. Such progressive changes are shaking the current farming strategies and setting out new open doors along a scope of difficulties. This article features the capability of remote sensors and IoT in horticulture, just as the difficulties expected to be confronted when incorporating this innovation with the conventional cultivating rehearses. IoT gadgets and correspondence procedures related with remote sensors experienced in horticulture applications are broke down exhaustively. What sensors are accessible for explicit agribusiness application, similar to soil readiness, crop status, water system, bug and bug recognition are recorded. How this innovation helping the producers all through the yield stages, from planting until reaping, pressing and transportation is clarified. Besides, the utilization of automated ethereal vehicles for crop observation and other great applications, for example, upgrading crop yield is considered in this article. Best in class IoT-based structures and stages utilized in farming are likewise featured any place appropriate. At long last, in view of this intensive audit, we recognize flow and future patterns of IoT in agribusiness and feature potential exploration challenges.

Background: Acne, also known as acne vulgaris, is a long-term skin disease that occurs when hair follicles are clogged with dead skin cells and oil from the skin. It is characterized by blackheads or whiteheads, pimples, oily skin, and possible scarring. It primarily a Acne vulgaris is one of the commonest skin disorders which dermatologists have to treat, mainly affect adolescents, though it may present at any age. Acne is definite as multifactorial chronic inflammatory disease of pilosebaceous skin diseases are common, especially in the developing countries. Mental health disorders are prevalent among those with skin diseases and affect their life and their treatment. Anxiety is one of the psychiatric disorders, and its symptoms were found among the patients with skin diseases. effects areas of the skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. The resulting appearance can lead to anxiety, reduced self-esteem and, in extreme cases, depression or thoughts of suicide.Acne vulgaris is a common condition extremely prevalent among teenagers and young adults under the age of 24 years. Nearly 85% of adolescents in this age group experience some degree of acneAcne vulgaris is a skin disease of chronic inflammatory nature. Although acne is not a life threatening, it has a deleterious impact on patients' social and psychological health.
Aim of the study:to assessment of Knowledge regarding acne vulgaris among secondary school students in Makkah.
Method:A cross-sectional study design. The current study was conducted Male and female secondary school students from selected governmental schools in Makkah. The total the sample size calculation will be 200 students. Female and male.
Results:Conclusion:Patients with dermatological diseases have a high level of anxiety and worry, especially with acne and skin disease affecting visible areas like the face. Further studies are required in Saudi Arabia to explore the true estimates of this problem.

Asthma is a global problem, its prevalence varies among different countries and cities and age groups. In children, asthma is one of the most common chronic diseases and one of the leading causes of morbidity and mortality.Bronchial asthma is the most common chronic disease of childhood. In recent years a consistent increase in the prevalence of asthma has been reported from various regions of the world. Concomitantly, the social and economic impact of the disease is also increasing. Children with asthma face multiple challenges that encompass learning how to cope with. Bronchial asthma (BA) is a public health problem in all countries irrespective of their level of development, being generally under-diagnosed and undertreated, and most asthma-related death commonly occurs in low-income and lower-middle income countries .As for Saudi Arabia, it is estimated that more than 2 million Saudis have asthma and the percentages range from 8% to 25% in Saudi children. In 2004, the highest prevalence of asthma was reported by physicians in Saudi Arabia (25%).
Aim of the study:To Assessment of knowledge of asthma and related symptoms in school-age children attending the primary health clinic inMakah city in Saudi Arabia 2019.
Method:A cross-sectional study was conducted attending the primary health care centers in Makkah, Saudi Arabia. An asthma knowledge questionnaire was used to measure the knowledge. During the March to June, 2019, participants were (80).
Results:General knowledge about asthma the majority of participant had average information were (43.75%) while weak Knowledgewere (12.25%) the data ranged from (4-15) by (Mean± SD) (12.113±4.12), while Knowledge about associated aspects of asthma the majority of participant had average information were (67.5%) while weak Knowledgewere (12.25%) the data ranged from (5-10.) (Mean± SD), (6.387±2.75).
Conclusion: In conclusion, the screening methodology adopted in this study could be applied for all children at the beginning of the school year, being simple and noninvasive measure. The prevalence of asthma in school children in is greater than that reported from most developing countries and closer to the rates reported indeveloped countries. Avoidance of pet's ownership at home, improving social class and premarital counseling for atopic persons are all recommended

Background
Antibiotics are the most commonly used drug group in hospitalized patients and primary health clinics as they are all over the world. Inappropriate or unnecessary use of antibiotics leads to adverse effects related with antibiotics, occurrence of resistant microorganisms, and increased therapeutic cost. With the Budgeting Application Instruction, which entered into force in 2003 for controlling antibiotic use, approval of an infectious disease specialist (IDS) was required for use of some differences in antibiotic knowledge and attitudes between parents of Medicaid-insured. It is unknown whether understanding has improved and whether previously identified differences persist.Efforts to reduce antibiotic misuse and overuse are necessary to curb additional increases in antibiotic resistance in developed and developing countries also in KSA saw increases in antibiotic use for children during the last 2 decades, no educational campaigns for patients and professionals, and introduction of new vaccines. ​
Aim of the study: To assessment of prevalence of antibiotic use for pediatric acute viral gastroenteritis attending the primary health clinics in Makah city in Saudi Arabia 2019.
Method: This is a cross-sectional study, thirty questions of children years of age who had suffered from acute gastroenteritis during the March to June, 2019 was conducted attending the primary health care centers in Makkah, Saudi Arabia. our total participants were (80).
Results:Oral antibiotics were preferred by 45.0% followed by intravenous route (30.0%), and intramuscular route in 8.75%. Antibiotics less than week were prescribed in about 43.0%. Duration from 7-14 days was recorded by 20%. Long-term antibiotics were prescribed by 3.0%. Questioning about the seasonal break out of viral gastroenteritis as stated by study individuals.
Conclusion: must be Antibiotic use based on consultation with an infectious diseases specialist decreased inappropriate antibiotic use. Acute gastroenteritis is a major source of morbidity and mortality among young children in developed and developing countries. Enter pathogenic viruses are regarded as particularly relevant causative agents.

Background:
     Physical activity (PA) is defined as any bodily movement produced by the contraction of skeletal muscles that results in a substantial increase in caloric requirements over resting energy expenditure. According to the World Health Organization(WHO), physical inactivity is considered the fourth leading risk factor for global mortality. Physical inactivity is associated with excess weight and adverse health outcomes. In particular, office-based screening of activity levels and physical activity counseling coupled with regular follow-ups and community support and referrals for physical activity, have been proven effective in increasing physical activity levels. In addition, the cost of integrating physical activity counseling and referral schemes into primary health care teams has been found feasible and cost-effective Physical activity can be defined as any movement of the body that requires energy expenditure.
 
Aim of this study: To Assessment of the Prevalence of Physical Activity among Adult Patients attend primary health care centers in Makkah city, Saudi Arabia.
 
 Methodology: Cross sectional design has been adopted. The study has been conducted in Makkah city, Saudi Arabia. The present study was conducted at primary health care centres in Makkah city. Systematic random sampling was being adopted to select persons during the March to June, 2019.The sample (300).
 Results: Exercise milieu these study results showed that Positive Exercise milieu proportions (62.0%), and Negative Exercise milieu proportions (38.0% ) while  the Range  (8-22)  Mean +SD (13.254±3.215) while Time expenditure the most of them negative were(69.0%)but positive (31.0%)while the Range (6-13) Mean +SD (10.812±2.77)
 
Conclusion: Physical inactivity among Arab adults and children/adolescents is high. Studies using harmonized approaches, rigorous analytic techniques and a deeper examination of context are needed to design appropriate interventions. Physical activity likely has a greater role in promoting health in disease populations than previously thought and may confer substantial reductions in disease burden Primary health care centers in Makkah should be active and able to provide health advice and behaviour to their patients. There will a strong intention to increase physical activity among physically inactive primary care physicians (PHCPs).

Background
     Contraception is an effective mean of Family Planning (FP) and fertility control, promotes maternal and child health. It is interesting to explore the perception and use of contraceptives among Saudi women. The usage of contraceptive has  a significant part in reducing fertility and control of population, which in turn is important for the development of the nation. Despite the advancements in current methods of contraception, unintended pregnancies are still widespread in the Kingdom of Saudi Arabia which adversely impacts the well-being and health of women and their families. Unintended pregnancies pose a major challenge to the reproductive health of young adults in developing countries. students are an important high-risk group in any society and emergency contraceptives can prevent unintended pregnancies and its consequences in this high risk group, contraception is unique among medical interventions in the breadth of its positive outcomes. An effective means of Family Planning (FP) and fertility control promotes maternal and child health.
Aim of the study: The study aimed to assessment the level of knowledge of emergency contraception among married women attending antenatal clinics, Makkah (2019).
Methods: cross sectional descriptive study has be conducted using saudi women who fulfilling the inclusion criteria, used to randomly select women from Primary Health Care Centers (PHCCs) in Makkah in Saudi Arabia . using a well-structured pretested questionnaire composed of four main parts to collect the data. Our total participants were (200).
Results: the majority of the participants answer the correct timing of emergency contraceptive pill (Within 5 days) were (86.0%)while IUD (Within 5 days) were (77.0%) while Total Knowledge regarding emergency contraceptive the majority of participants answer yes were (88.0%), regarding the ever using emergency contraception the majority of participants answer no were (75.0%).
Conclusion: In the light of the above results, there is an urgent need to improve the knowledge of Saudi women in age of fertility towards the use of modern contraceptives, low utilization was notices mainly due to religious concerns. Awareness programmers should be organized by the management on emergency contraception and other modern contraceptive methods.

Background
Health research training is an essential component of medical education and a vital exercise to help develop physician research skills Research experience is invaluable to the physician's evidence-based practice as it imparts skills such as literature search, collecting, and analyzing data and critical appraisal of evidence.Training for research skills and experience of research early in career has been associated with continued professional academic work and may help inform residents' career decisions. The medical education system in India does not incorporate research methodology as a part of the curriculum. It is seen that research programs in medical colleges get the lowest priority. There are a numbers of reasons, including lack of funding and manpower resources, responsible for the poor quality in research-oriented medical education. Research is a systematic process to achieve new knowledge, science or invention by the use standard methods. Health research has an impact on the prevention, diagnosis and treatment of diseases and especially on health care programs policy.
Aim of the study:To assessment of the Knowledge toward medical research among health care worker in the primary health care at Makkah 2019.
Method:This is a cross sectional studyconducted at primary health care at Makkahbetween August 2019 and October 2019 was carried out on sample size (190) would be. In order to account for non-response and achieve more generalizable results, the investigator will increase the sample size up to (200) . sampling technique has be used then simple random.
Results:majority of our study weak Knowledge were constitutes (42.0%). While the average of Knowledge were constitutes (39.0%) but high were constitutes (19.0%) and the Range is (1-10) while Mean ±SD (5.113±2.011). Also a significant correlation between Knowledge toward medical research were P-value<0.001
Conclusion:In the present study, it had been found that postgraduate physicians in the primary health care had unsatisfying knowledge of health research. they'd positive attitude towards research, however they didn't remodel their data , but they failed to transform their knowledge  due to lack of time and lack of research curriculum. There is need to encourage postgraduate students to carry out research through provision of technical assistance and essential infrastructure during their postgraduate training program.
 

Background:
       Saudi Arabia is considered to be one of the highest countries in the Middle East for the incidence of diabetes mellitus. Data are lacking regarding knowledge about diabetes mellitus among school students in Saudi Arabia. Diabetes mellitus is a major metabolic disorder currently affecting over 350 million people worldwide. Also, another one billion people in the world are pre-diabetic, who may eventually end up with full- blown diabetes. Type 2 diabetes mellitus is fast becoming a global epidemic and the number of individuals with diabetes in the world is expected to reach 330 million by 2030. The rate of T2DM is rapidly increasing in developing countries, particularly among younger age groups a cross-sectional study indicated that Saudi adolescents exhibited more health-related knowledge than the older population; the majority of the adolescents believed that obesity was dangerous and that regular exercise was beneficial for their health. Saudi adolescents are at a high risk of developing diabetes as many suffer from obesity, a sedentary lifestyle and hereditary diabetes. In 2004, almost a quarter (23.7%) of the Saudi population was diagnosed with T2DM; this was 10 times the number of diabetic individuals in 1980.6 The occurrence of T2DM has been linked to the high rate of overweight adults (35.5%) in the Saudi population and the number of overweight and obese Saudi adolescents is high among both genders.
Aim of the study: The study aimed to assess the knowledge of diabetes mellitus among secondary school students at the Makkah in Saudi Arabia 2019.
Method: cross sectional descriptive study conducted among secondary school students at Makkah, during the April to June, 2019, the Sample size of diabetic secondary school students. Our total participants were (500).
Results:knowledge of the participant toward diabetes mellitus study results show the majority of participant had average information were(61.0%) while weak knowledge were (31.0%) the data ranged from (4-13) by mean ±SD (9.011±2.314).
Conclusion: The level of knowledge and awareness of a considerable number of high school students regarding DM was inadequate, and some of them possessed various misconceptions about this particular chronic disease. Health authorities and school authorities in the region should offer special efforts to improve the level of knowledge and awareness of the students through regular health education campaigns.Diabetes Day should be celebrated in all schools and workshops and lectures given by professionals in collaboration with Ministry of Health on this day are recommended to increase the level of awareness of diabetes

1. Background
Diabetic retinopathy (DR) is a well-known complication of diabetes mellitus (DM) and a major cause of
vision loss. Increased knowledge of DR is crucial for the prevention and early diagnosis of the disease and
preservation of vision, diabetes mellitus is a disorder, characterized by an imbalance in blood glucose
levels. The prevalence of diabetes mellitus is increasing globally.The global diabetes prevalence in 2019 is
estimated to be 9.3% (463 million people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million)
by 2045. Long term, continuous hyperglycemia leads to vasculature-related disorders, including those
affecting the eyes, such as retinopathy, diabetes mellitus is an endocrine disease with chronic elevation in
blood glucose levels. If not managed, it can lead to multi-organ damage also diabetes mellitus is a
metabolic disease that is characterized by distortion in the metabolism of carbohydrates, lipids, and
proteins and involves hyperglycemia. Diabetes mellitus has different types. Several complications are
associated with diabetes including diabetic retinopathy.
This study aimed: This study aims to assess the knowledge of diabetic retinopathy and compliance with
diabetic retinopathy patients in Makkah, Saudi Arabia.
Methods: cross-sectional study was conducted among the diabetic population from May to September 2019
in Makkah, Saudi Arabia. The patients were selected randomly from the general population visiting the
Makkah diabetic center and primary healthcare clinics in Makkah. A self-administered questionnaire was
distributed to assess the knowledge of diabetes and its complication diabetic retinopathy. Our total
participants were (300)
Results: Conclusion: The level of knowledge regarding diabetic retinopathy among participants with
diabetes type 2 in Makkah is relatively high. However, participants’ motivation to attend an ophthalmology
clinic for an eye assessment was poor in the study, thus delay early diagnosis and management.

It is the goal of this project to automate a standard power hacksaw machine in order to
increase the productivity of workpieces by utilising a Microcontroller. Two inputs are needed
from the user to operate the automated cutting machine: the number of pieces to be cut and
the length of each piece. To be slashed. Using a keypad and an LCD display, the user may
enter the information they need. check the information he has provided. In order to cut the
work-piece, the operator does not need to measure its length or to put it into the machine.
unloading the chuck each time after cutting a new piece. As soon as we get the two inputs we
need from them, we're ready work-length specified by the user is automatically fed into the
machine. A chuck is used to hold the component in place as it is chopped. There have been a
lot of cuts made. With the use of a conveyor, the machine feeds the work-piece. An IR sensor
and a DC motor guarantee that the feeding stops when the appropriate length has been
achieved. When cutting, a cylinder is utilised to keep the workpiece in place. It's done using an
AC motor. Workpieces must be cut using a reciprocating action. The reciprocating mechanism
has a self-weight linked to it. Hacksaw blade penetration mechanism to give the appropriate
downward power needed for the workpiece. An automatic limit switch will be activated after
one piece of material has been sliced, which is detected by the self-weight mechanism. The
microcontroller will restart the cycle process if the required number of workpieces have not
been cut.

Rusting of Polyurethane (PU) coated steel sample which is used in most of the
chemical industries has become a problem requiring necessary attention and corrective
prevention method. Composite materials are looked at as the alternatives to address this
issue. As these composites are not attacked by the chemicals in the industries, acids in
present problem. However, composites have complex manufacturing processes and need
high cost. The glass fibre plates, composites, cut in to the necessary lengths and
dimensions. Then joined at Web Flange Joint (WFJ) with the help of adhesives to reduce
the process complexity and cost. It is observed that Huntsman Araldite gives better results
as adhesive to be used at WFJ. This is validated using Finite Element Analysis (FEA) with
ANSYS tool. The Hundsman Araldite failure strength is much better at the WFJ area. In
addition to this, cleats are used with 4 mm, 12 mm for increasing the WFJ area and
improve the load carrying capacity of the composite I- Beam. The results of experiments
have clearly shown that the glass fibre immersed in the acidic bath solution for certain
period has no reaction as such. Hence shown much improved resistance to acidic attack
and no rusting as such. Appreciable correlation between experimental and analytical
results indicated improved performance of Composite Beam in given chemical (acidic)
environment. It is recommended to use the composite I – Beams in acidic environments in
place of steel beams to have improved rusting behaviour and lonf life of the beams.

Background
Workplace violence (WPV) is a serious worldwide concern, especially for health care professionals when
compared with workers in other industries. Violence in the health care sector harms both patients and health
care professionals and causes enormous economic losses. Victims of WPV show signs of anxiety, depression,
and low efficiency in their work performance, which may decrease the quality of the service that they provide.
Among health care professionals, nurses who have direct contact with patients face numerous risks related to
WPV. Therefore, it is important to recognize risk factors that can be used to reduce the incidence of WPV
against nurses. Emergency healthcare workers (HCWs) have a high risk of exposure to violence with negative
personal consequences. Violence is an occupational hazard in hospitals. Occupational researches have gradually
shifted focus from traditional, visible environmental risk factors, such as physical, chemical, biological exposure
or ergonomic problems, to the invisible, psychological harm that maybe present in the workplace.
Aim of the study: To assessment of Prevalence of Workplace Violence among and Nurses and Physicians at
Emergency Department in Primary Health Care Centers and confirm the factors influencing such violence.
Method: Cross-sectional analytical study has been conducted at emergency departments (EDs), Primary Health
Care Centers in Makkah city, during data collection period 2019, the total sample has been (400) nurses and
physicians.
Results: Regarding the age the highest age were (35.0%) were (30-40) years and the data ranged from (22-57)
by mean ±SD (38.315±9.816), were females (57.0%)while males. The majority of the participated nurse were
(67.0%), followed by doctor were (33.0%). Regarding the qualification, the majority of participated heave
Bachelor were (28.0%) followed by Resident (21.0%), the participated experience in from 6-10 years were (31.
0%).More than half of the participants were yes to physical or verbal violence and their percentage was (75.
0%).Conclusion: Workplace violence was prevalent, and verbal abuse was the commonest type among HCWs in
emergency departments of PHC. Workplace violence, a possible cause of job stress, has recently become an
important concern in occupational health. Almost half of the ED nurses and physicians experienced one or more
WPV incident.

There is a tremendous difference in the distribution of health care in a growing country like India. Although about 75% of the Indian practitioners reside in ru- urban, and nearly 75% of medical professionals reside in urban areas. Most of the rural population ( Approximately 620 million) do not have primary medical facilities. The Indian Government spends about 0.9% of its GDP on health services. A large chunk of it goes to urban areas and rural areas receive very little part of the allocated money
In modern times most governments of all countries in the world are facing the common problem of providing quality health services at an affordable cost to their citizens. The biggest hurdle in this issue is to bring the health workers/doctors and patients together at a commonplace and at the same time. To make it happen either of the group has to travel. However, Internet-enabled communication technology has made it easy, convenient, and cost-effective. None of the parties have to travel to reach a commonplace. This has brought a tremendous opportunity to all governments to improve the quality of health services throughout the world.
Telemedicine has the ability to improve all Indians' access to high-quality health care. India has poor and average patient care, with only one doctor per 1,445 people. This discrepancy is particularly prevalent in the rural and tribal areas because most doctors prefer and choose to practice in cities. According to a WHO study, 59.2% of all health workers are located in urban areas which constitute 27.8% of the total population. However, 40.8% of all health workers are working in rural areas, which, are home to 72.2% of the population. Telemedicine can help exacerbate this inequality by allowing doctors in urban areas to consult with local people, including specialized care when needed.

Background: To study and compare the hypertonic nasal douching with normal saline nasal douching in post operative endoscopic sinus surgery.

This study was conducted at one of the private orchards in Al-Rumaitha area of ​​Al-Muthanna Governorate during the two growing seasons 2019. Ten males were selected from date palms of seed origin whose pollen was used in pollination of female pollen of the two date palm cultivars Zuhdi (V1) and Sayer (V2), by three palm trees of the same age. The results of the study showed the superiority of the female Al-Sayer cultivar on the thickness of the cuticle layer and the thickness of the epidermal layer 50.17 and 72.83 µm. The M10 male excelled in the two mentioned characteristics 49.37 and 82.17 micrometers. Also, the cultivar Zuhdi was significantly superior on the thickness of the stone cells, the thickness of the outer mesocosm and the thickness of the subepidermal layer 415.99, 715.60 and 238.19 µm, it was also noted that the thickness of the tannin layer of the female Al-Sayer variety is 196.37 µm. The second interaction recorded a clear significant effect for all the studied traits.

A laboratory experiment was conducted in one of the laboratories of Silo General Company for Grain Trading the variety Eba 99 during the 2019 season in order to study the response of the seeds to treatments of Moisture  and heat. -7, 20 and 32), and the second factor was three Moisture  treatments (10%, 14% and 16%),  temp 32 was significantly superior, were highest value of germin perc. and reached 94.33 %, while temp. 7 was  lowest value and reached 89%.Moisture level treatment exceeded 14% and washighest germin perc., which reached 92%, and 16% gave the lowest percentage of germ. that reached 90%.The interaction between temperature and Moisture  levels showed significant superiority, and the interaction treatment 10x32 gave the highest value of 97%., The treatment of the heat level 32 was significantly superior to the rest of the treatments and gave the highest value of specific weight  77.03 kg  while the treatment of the heat level - 7 gave 75.47 kg with an insignificant difference from the heat level 20, which amounted to 75.20 kg, The treatment of the level of moisture in the specific weight was significantly superior, and the treatment of 16% gave the highest value, and it reached 75,9 kg, the treatment of heat 32 was superior to the speed of germin. and gave the lowest value of 3.44 days, while treatment 37 gave the highest value of 4.22 days The humidity level of 10% gave the lowest number of days for germin., while the level of ride of 16% gave the highest value of the number of days to reach germin. 4.22days, that temperature degree treatment of 32 °C gave the highest in weight of 1000 grains 35.50 g.

A field experiment was carried out in the Badia of Al-Muthanna, Faidat Umm Al-Shih, for the 2018-2019 season, to determine the effect of adding levels of agricultural polymer and levels of irrigation on some chemical and physical properties of the soil and the production of wheat crop (Triticum aestivum L.). The experiment included three levels of Absorption Sup super (ASP Polymers (0, 40 and 80) kg ha (P0, P1 and P2) and four levels of irrigation (W3, W4, W5 and W6). Three seasons, four seasons, five seasons, and six seasons, the soil was divided into three replicates to find out the best number of irrigations with the best amount of polymer added in production and the characteristics of the studied soil. The results showed the effect on the soil properties, the addition of the agricultural polymer at a level of 80kg ha and the irrigation level W6 showed a significant decrease in the electrical conductivity of the soil, reaching 1.9 decimens, the CEC values ​​also increased to 13.80 cmol, which is the highest level, and the bulk density values ​​decreased to the level of 1.39 gm cm³, which was the lowest level in the experimental treatments. As for the soil reaction, it reached the lowest level (7.60 pH) against the level of polymer P1, as for the effect on wheat production, it was significant, as the biological yield reached the polymer level 80 kg ha, 11.95 megagrams ha^-3, which was the highest production achieved by the experimental treatments, while the yield of the wheat crop was 5.55 megagrams ha^-3, which was the highest. The effect of irrigation levels on biological production and productivity reached the highest irrigation level (W6), where it was respectively 11.40 and 4.51 mg ha^-3 as an average, as the study showed that the addition of 80 kg/ha agricultural polymer with six irrigations per season gave good productivity and significantly affected Positive on soil physical and chemical properties in desert soils

Background: To assess prevalence of P. aeruginosa and antibiotic sensitivity from respiratory samples.
Materials and Methods: One hundred twenty respiratory samples of both genders were taken for study.
All samples were processed and Pseudomonas aeruginosa was identified by various biochemical test. Antimicrobial susceptibility testing was done by disk diffusion method as per CLSI.
Results: Out of 120 patients, males were 70 (58.3%) and females were 50 (41.7%). Out of 120 respiratory samples, 30 (25%) had P. aeruginosa. Antibiotic sensitivity pattern of Pseudomonas isolates was seen 74% to Ciprofloxacin, 86% to Ofloxacin, 57% to Ceftriaxone, 65% to Ceftazidime, 84% to Amikacin, 85% to Meropenem and 63% to Imipenem. The difference was significant (P< 0.05).
Conclusion: There is high prevalence of Pseudomonas aeruginosa in respiratory samples.  Increasing resistance of Pseudomonas aeruginosa needs constant surveillance of antimicrobial resistance trends and administration of appropriate antibiotics.

Aim: A research with the goal of determining the antibiotic susceptibility pattern of uropathogens responsible for catheter-associated urinary tract infections (CAUTI) in a tertiary care hospital. Materials and Methods: There were a total of 300 individuals that required catheterization. During her daily rounds, the infection control nurse gathered all of the pertinent information, such as the patient's name, age, sex, the date of their catheterization, and laboratory findings. The CAUTI diagnosis was carried out in accordance with the CDC criteria that were issued in 2009. Patients of both sexes who were more than 18 years old and who had been placed on a Foley's catheter for at least 48 hours were considered for inclusion in the research. This selection criteria were used to determine who would be included in the study. Results: Out of 300 catheterized patients, 20 developed CAUTI. The overall incidence was 6.67%. Male patients were more than the female patients for catheterization. Catheterization days ranged from 2 days to 12 days. The most common uropathogens were E. coli (40%) and Klebsiella pneumoniae (40%) followed by Pseudomonas aeruginosa (10%) and Acinetobacter species (10%) from the cases of CAUTI. Imipenem was the single best antibiotic for all pathogens except Pseudomonas aeruginosa where Amikacin was the drug of choice. The Acinetobacter species also showed very high resistance to all antibiotics except Imipenem. Conclusion: CAUTI continued to be a significant risk to the health of patients and a difficult obstacle for the staff working in infection control. The implementation of appropriate care packages and the provision of ongoing education to health care staff each play a significant part in the reduction of CAUTI rates, which in turn leads to a reduction in the morbidity of patients and the length of their stays in hospitals.

Facial fractures and concomitant cranial injuries carry a significant potential for mortality and neurological morbidity in young adults.
Aim
To analyze the characteristics of head injuries and associated facial injuries and the management options and outcome following craniofacial trauma.
Materials and methods
This retrospective study was performed at Justice K. S. Hegde Charitable Hospital and AB Shetty Memorial Institute of Dental sciences, Deralakatte, Mangalore. After Ethical Committee approval, hospital charts and radiographs of 100 consecutive patients treated for craniofacial trauma by the Department of Oral and Maxillofacial Surgery and Department of Neurosurgery between January 2004 to December 2004 were reviewed.
Results
There were total 100 patients in the present study who sustained cranial and/or maxillofacial injuries. Majority of the patients were in 2nd to 4th decade (79%) with a male to female ratio of 8.09:1. Road traffic accidents were the common cause of craniofacial trauma (54%) followed by fall from height (30%). Loss of consciousness was the most common clinical symptom (62%) followed by headache (33%). Zygoma was the most commonly involved facial bone 48.2% (alone 21.2%, in combination 27.2%). Majority of the patients had mild head injury and were treated conservatively. Reasons for surgical intervention for intracranial lesions were compound depressed fracture, contusion and intracranial hematoma. Operative indications for facial fractures were displaced facial bone fractures. Major causes of mortality were associated systemic injuries.

Knee osteoarthritis (KOA) accounts for nearly four-fifths of osteoarthritis (OA) worldwide and increases with obesity and age¹Osteoarthritis (OA) is one of the most common causes of pain and disability, representing a significant burden for the individual and for society
Methods: A community based cross sectional study was conducted to find out the prevalence of Knee Osteoarthritis among rural population of age group above 40 years and also to find out the association between risk factors and prevalence of Knee OA with the sample of 370 by simple random sampling
Result: The prevalence of  knee osteoarthritis was found to be 31.6% in our study The  prevalence was found to be highest in the age group70 and above. The prevalence  of knee OA in females was more than the males. The lifestyle risk factor like DM and BMI ≥25 was found to be significantly associated with knee OA. (p <0.05).
Conclusion:The prevalence of knee osteoarthritis was found to be highest among elderly (>70) population, more common in females, significantly associated with obesity

Rheumatoid Arthritis (RA) is a chronic autoimmune disease, causing joint damage and functional impairment. Worldwide prevalence of RA is around 0.5 to 1 percent. Disease severity assessment in Rheumatoid Arthritis patients is done routinely using Disease Activity Score in 28 joints with ESR (DAS-28 ESR) and Clinical Disease Activity Index (CDAI). The present study sought to evaluate and correlate disease activity in RA patients from Southern India using DAS-28 ESR and CDAI.
Material and methods: First 100 newly diagnosed Rheumatoid Arthritis patients satisfying American College of Rheumatology/ European League Against Rheumatism (ACR/EULAR) 2010 criteria for RA who attended Rheumatology clinic in a tertiary care hospital in Southern India from April 2017 to September 2017 were studied. Based on previous established values, the patients were divided into low, moderate, and high disease activity groups. Chi-square test and Mann-Whitney U test were used to study association between the disease severity score and clinical factors. Spearman rank correlation was performed to assess the correlation between DAS-28 and CDAI scores.
Results: Median age of patients was 47.5 years, predominantly female. Elevated CRP was observed in 85% patients. All patients were classified having high disease severity for DAS 28 ESR score with mean score 6.8 (±0.8). Nine patients had moderate severity, while 91 patients had high disease severity CDAI score with mean score of 34.8 (±11.3). There was strong correlation between DAS 28 ESR score and CDAI score (r=0.94).
Conclusions: All patients enrolled had high disease severity using DAS 28 ESR score, while 91 patients were classified having high disease severity using CDAI in the present study. There was strong correlation between the DAS 28 ESR score and CDAI score. From an outpatient setting from Southern India, CDAI may be a preferred disease assessment tool in day-to-day clinical practice in assessing RA patients because it does not include laboratory tests and complex mathematical calculations.

Lower limb amputation (LLA) is a procedure that changes one's life. There is continuous discussion about whether through-knee amputations are better than above-knee amputations, despite the fact that shorter residual limbs are known to put patients under more physiological pressure than longer residual limbs. By methodically compiling and combining public and unpublished data on this topic, this investigation seeks to answer that question.
Aim: This study examines the post-traumatic quality of life, mobility, and prosthesis use in lower limb amputees. Moreover, it assesses how rehabilitation affects individuals with amputations' functional wellbeing.
Materials and methods: 50 lower limb amputee cases were examined in a retrospective and prospective study between 2016 and 2019 to assess the quality of life using the SF-12v2 score, prosthesis usage, mobility of 500 metres, and stump length.
Result: The patients in our research ranged in age from 13 to 83, with a mean age of 44.08 years. Out of 50 patients, 10 complained of stump discomfort. 20 of 50 patients reported feeling phantom pain. 72% of amputees above the knee and 95% of those below the knee exhibited mobility of more than 500 metres. The SF-12 score demonstrated that amputees below the knee had a higher quality of life than those above the knee. There were just 5 below-the-knee amputees employed, and no patients above the knee.