Retrospective Cohort Study on Determinants of Mechanical Ventilation Duration of COVID-19 ICU Patients

Background In the face of the ongoing global health crisis posed by COVID-19, it becomes imperative to understand the disease's dynamics, particularly in specific regions. This study provides a detailed examination of the factors influencing mechanical ventilation (MV) duration among COVID-19 patients in an intensive care setting, focusing on a diverse patient cohort from the Al Hassa region of Saudi Arabia. The primary aim of this study was to identify key demographic factors, clinical outcomes, and comorbidities that affect the duration of MV among ICU patients with COVID-19. This understanding is crucial for enhancing patient care and informing healthcare strategies in the context of the pandemic. Methods A retrospective cohort study was conducted involving patients diagnosed with COVID-19 and admitted to the ICU in the Al Hassa region. The total number of participants was 1,259. Using a systematic sampling method, these participants were chosen to create a representative sample that reflects the prevailing treatment protocols in ICUs across these hospitals. Data encompassed patient demographics, comorbidities, clinical outcomes, and MV duration. Statistical analyses were employed to explore the associations between these variables. Results Our findings reveal a total of 1,259 participants significant associations between MV duration and various factors, including nationality, legal status, travel history, and comorbidities like heart failure and immunocompromised status. These insights are instrumental in understanding the nuances of COVID-19 management in critical care. Conclusion The study provides valuable insights into the determinants of MV duration in severe COVID-19 cases, emphasizing the need for individualized patient care approaches. It highlights the complexity of managing COVID-19 in ICU settings and underscores the importance of tailored healthcare responses to this global health challenge, particularly in the Al Hassa region.

Clinical Characteristics, Complications, and Predictors of Poor Outcome Among Hospitalized Adult COVID-19 Patients: A Retrospective Cohort Study

Background

Many international studies have reported the outcomes and predictors of coronavirus disease 2019 (COVID-19); however, only a few national studies have reported predictors of poor outcomes among adult hospitalized patients with COVID-19. Therefore, this study aimed to describe the clinical characteristics and complications of COVID-19 and identify predictors of poor outcomes.

Methods

This was a retrospective cohort study. All adult patients confirmed with COVID-19 who were admitted at the King Abdulaziz Medical City (KAMC)-Jeddah between March 1, 2020, and December 31, 2020, were included; pediatric and pregnant patients were excluded. The clinical features and complications of COVID-19 were tested for association with poor outcomes (intensive care unit [ICU] admission or death) using chi-square and Fisher’s exact tests. In addition, logistic regression analysis was performed to identify the predictors of poor outcomes.

Results

A total of 527 patients were included in this study. Forty-two patients (8%) (6-10, 95% confidence interval [CI]) died: 13 in the general wards and 29 in the ICU. Of the 84 patients admitted to the ICU, 65 underwent invasive mechanical ventilation. Poor outcome affected 97 patients (18%) (15-22, 95% CI). Shortness of breath, oxygen saturation <92%, and abnormal chest x-ray findings were associated with poor outcomes (P-value < 0.001). In addition, lymphocyte counts were significantly lower, while c-reactive protein levels were significantly higher among patients with poor outcomes (P-value < 0.001). The most common complications were acute cardiac (83 patients, 16%), acute kidney (78 patients, 15%), and liver injuries (76 patients, 14%). Predictors of poor outcome were the updated Charlson comorbidity index (CCI) (odds ratio [OR] 1.2 [95% CI 1.1-1.4]), liver injury (OR 2.6 [95% CI 1.3-4.9]), acute kidney injury (OR 4.3 [95% CI 2.3-7.8]), and acute cardiac injury (OR 5.1 [95% CI 2.8-9.4]).

Conclusions

COVID-19 disease is associated with significant morbidity and mortality. Predictors of poor outcomes among COVID-19 hospitalized patients were the updated CCI, liver injury, acute kidney, and acute myocardial injuries. Subsequently, the risk of poor COVID-19 outcomes is increased among patients with multiple comorbidities and/or multiple COVID-19 complications.

Comparative effectiveness of EDTA and citric acid assisted phytoremediation of Ni contaminated soil by using canola (Brassica napus)

Phytoremediation is an ecofriendly technique to clean heavy metals from contaminated soil by the use of high biomass producing plant species. Chelators can help to improve this biological technique by increasing metal solubility. Therefore, a pot experiment was conducted to determine the effect of the chelators EDTA and citric acid (CA) in phytoremediation of Ni contaminated soil by using Brassica napus (canola). Two cultivars of B. napus, Con-II (tolerant) and Oscar (sensitive), were selected after screening and exposed to NiSO4 at 30 ppm at the time of sowing. CA (10 mM) and EDTA (1.5 mM) were applied either alone or in combination with each other after two weeks of Ni treatments. Different parameters like morpho-physiological and biochemical data were recorded after 15 days of chelate application. The results highlighted the successful use of chelating agents (CA and EDTA) not only to ameliorate Ni stress but also to enhance Ni accumulation which is prerequisite for phytoremediation. The basal application of 10 mMCA and 1.5 mM EDTA concentration proved to be effective for the growth of plants. The combination of chelating agents failed to show any synergistic effects.

Frequency of Neuropathic Sensory Symptoms Among Patients With Uncontrolled Diabetes Mellitus in Security Forces Hospital, Riyadh, Saudi Arabia

Background

Diabetic peripheral neuropathy (DPN) is a chronic sensorimotor length-dependent and symmetrical polyneuropathy. Some peripheral neuropathies have painful presentations, and some are painless. DPN can have a potential impact on the patient's life.

Objectives

This study was conducted in order to investigate the frequency of neuropathic sensory symptoms among patients with uncontrolled diabetes mellitus.

Methods

This is a cross-sectional study conducted in the Security Forces hospital using the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire. The questionnaire was administered by contacting patients through the phone. Patients with uncontrolled diabetes (HbA1C >9) were included in the study.

Results

This study included 285 participants; 58.9% had type II diabetes and 41.1% had type I diabetes, 156 (54.7%) were females, and 129 (45.3%) were males. Most of the patients (51.1%) were 45-64 years old and the majority were non-smokers (77.9%). Patients with neuropathic pain were 182 (63.9%); 79 (43.4%) of them were males and 103 (56.6%) were females. The prevalence of neuropathic symptoms was much higher in females than in males.

Conclusion

The prevalence of painful DPN is high among patients with long-term uncontrolled diabetes mellitus. Older, unemployed, and low-educated patients are at higher risk of developing painful DPN. Proper glycemic control and lifestyle modifications are essential in preventing the progression of this condition.

The Prediabetes Outcome at National Guard Primary Health Care Centers in Riyadh, Saudi Arabia: Retrospective Chart Review

Objectives

To identify the outcome of prediabetes and the interventions that have been implemented for prediabetic patients at primary healthcare centers (PHCs) affiliated with King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Methodology

This retrospective chart-review study was carried out using the BestCare electronic health records (EHRs) system. Data from the PHCs of King Abdulaziz Medical City, Riyadh, Saudi Arabia were extracted. Inclusion criteria were patients with prediabetes who were diagnosed between January 2015 and December 2016, with at least one follow-up visit. Variables included demographics, comorbidities, blood sugar lab results, and lipid profile measurements at each visit and intervention at the time of the initial diagnosis. Fisher's Exact test, sign test, and Kruskal-Wallis test were used to assess the differences for non-normally-distributed variables, while a paired t-test was conducted for paired and normally distributed continuous variables. Data were analyzed using the statistical program SAS, version 9.4 (SAS Institute Inc. Cary, NC).

Result

Of the 92 patients followed up with for three years, 76.08% remained in the prediabetic range, while 16.4% regressed to a normal glycemic state (NGS) and 7.6% progressed to the diabetic range after intervention and follow-up for three years. Metformin use was not significant in the glycemic outcome. In comparison to the baseline, there was a considerable reduction in fasting blood sugar (FBS) and glycosylated hemoglobulin A1c (HbA1c) at the end of the follow-up.

Conclusion

We found that most of the patients remained in the prediabetic range after the three-year follow-up, with or without intervention. A commonly prescribed pharmacological intervention like metformin showed no regression benefit in most patients. More extensive prospective studies are needed to evaluate the outcome and adherence to different interventions.

Acute Complications of Diabetes Among Pilgrims During Hajj 2017: A Brief Report

INTRODUCTION

Diabetes mellitus (DM) was reported as one of the most common non-communicable diseases during Hajj. However, few studies evaluated acute complications of DM during Hajj. Therefore, this study aims to explore the most common acute complications among pilgrims with DM during Hajj 2017 and its clinical presentations.

METHODS

This is a descriptive cross-sectional study. Data were collected using an anonymous questionnaire from the database of pilgrims with DM, who sought medical care in mobile clinics in Mina during the peak period of Hajj from 31 August to 4 September 2017. Data were entered afterwards into an Excel sheet and analyzed using SPSS.

RESULTS

In this study, a total of 281 pilgrims were recruited, male to female ratio 3:1. Out of 281 pilgrims, 199 (70.8%) had foot injuries, 77 (27.4%) had hyperglycemia, and 37 (13.2%) had hypoglycemia, noting that some of them presented with more than one complication. Most of the participants who developed foot injuries, presented with redness (28.8%) and bullous (20.6%). The most reported symptoms among hyperglycemic pilgrims were polydipsia (17.1%) and dry mouth (16.4%). Also, the most reported symptoms of hypoglycemia were fatigue (14.9%) and headache (12.5%). In addition, pilgrims with type 2 DM reported a higher rate of acute complications compared to type 1 DM (81.8% versus 18.2%, p = 0.33).

CONCLUSION

The most common acute complication of diabetes during Hajj is foot injury. Pilgrims who suffered from hyperglycemia presented mainly with polydipsia, while those who developed hypoglycemia presented mainly with fatigue. There was no statistically significant difference according to the association between the type of diabetes and the occurrence of acute complications.

Crystal structure of 5-(4-fluorophenyl)-4-methyl-2,4-dihydro-3H-1,2,4-triazole-3-thione, C9H8FN3S

C9H8FN3S, monoclinic, P21/c, a = 15.8636(6) Å, b = 7.6641(3) Å, c = 16.4472(7) Å, β = 106.016(2)°, V = 1922.04(13) Å3, Z = 4, R gt(F) = 0.0348, wR ref(F 2) = 0.1001, T = 296(2) K.

Measuring the health literacy level of Arabic speaking population in Saudi Arabia using translated health literacy instruments

Background:

Health literacy is an essential predictor of health status, disease control and adherence to medications.

Objectives:

The study goals were to assess the health literacy level of the general population in Saudi Arabia using translated Gulf Arabic version of the short-version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and Single Item Literacy Screener (SILS) tests and to measure the relationship between health literacy and education level.

Methods:

The study was a cross-sectional with a convenience sample of 123 participants from the general population in Riyadh. Data were collected using the modified (Gulf) Arabic versions of both S-TOFHLA and SILS. Fisher’s Exact test was used to measure the difference of the health literacy scores according to the education degrees and Cronbach’s alpha was used to measure the internal consistency of the S-TOFHLA items.

Results:

More than half (55.4%) of the participants were male, 50.4% had a middle school or less education level, and we found that 84.4% had adequate health literacy as measured by the S-TOFHLA, compared to 49.6% as measured by SILS. The Fisher’s Exact test showed a significant difference (P<.05) in the S-TOFHLA and SILS scores according to education categories.

Conclusions:

The level of education has a significant positive association with S-TOFHLA and SILS results. The Gulf Arabic version of S-TOFHLA is a reliable test with a good internal consistency and a significant positive correlation between the two parts of S-TOFHLA. We recommend the use of S-TOFHLA or SILS at the first patient visit.

Clinical relevance of vitamin C among lead-exposed infertile men

AIMS AND OBJECTIVES

A cross-sectional study was designed by targeting 120 male workers occupationally exposed to lead from a battery-manufacturing industry situated at the Patancheru industrial area, Hyderabad, Andhra Pradesh, India, to see the impact of lead on testicular dysfunction with reference to infertility. Further, the study was designed to see the in vivo effect of an antioxidant in the form of vitamin C, prophylactically administered at the dose of 1000 mg/day for five consecutive days in a week for 3 months.

METHODOLOGY

Blood samples and semen samples were collected from 120 men in the study group exposed to lead, and 120 healthy human subjects, who have no history of exposures to chemicals, were selected as controls for comparison. The mean age of the workers who participated in this study falls in the range of 25-55 years. The semen samples were collected with due consent of the industrial workers to perform the conventional semen analysis and the measure of sperm DNA fragmentation by the comet assay.

RESULTS

Industrial workers showed a statistically significant increase in sperm motility (p<0.001), sperm total count (p<0.001), and a statistically significant decrease in abnormal sperm morphology (p<0.001) after vitamin C prophylaxis. The comet assay also showed similar results, where there is a statistically significant decrease in alkaline-labile sites and a statistically significant decrease in the mean tail length of the comet when compared to the control group (p<0.001) after vitamin C prophylaxis.

CONCLUSION

This study leads us to conclude that the lead compound interferes with the testicular function, inducing its activity and also by exerting its effect on sperm DNA, leading to fragmentation. Further, the prophylaxis with antioxidant treatment may offer protection against the reactive oxygen species (ROS)-induced DNA damage, which is a major cause in the etiology of male infertility.

Functional analysis and structure determination of alkaline protease from Aspergillus flavus

Proteases are one of the highest value commercial enzymes as they have broad applications in food, pharmaceutical, detergent, and dairy industries and serve as vital tools in determination of structure of proteins and polypeptides. Multiple application of these enzymes stimulated interest to discover them with novel properties and considerable advancement of basic research into these enzymes. A broad understanding of the active site of the enzyme and of the mechanism of its inactivation is essential for delineating its structure-function relationship. Primary structure analysis of alkaline protease showed 42% of its content to be alpha helix making it stable for three dimensional structure modeling. Homology model of alkaline protease has been constructed using the X-ray structure (3F7O) as a template and swiss model as the workspace. The model was validated by ProSA, SAVES, PROCHECK, PROSAII and RMSD. The results showed the final refined model is reliable. It has 53% amino acid sequence identity with the template, 0.24 Å as RMSD and has -7.53 as Z-score, the Ramachandran plot analysis showed that conformations for 83.4 % of amino acid residues are within the most favored regions and only 0.4% in the disallowed regions.

Effect of benzene exposure on fertility of male workers employed in bulk drug industries

AIMS AND OBJECTIVES

Industrial workers are constantly exposed to benzene, especially at the production unit. The present investigation explores any association of the outcome of various reproductive malfunctions in terms of infertility and other related factors as a result of benzene exposure.

METHODOLOGY

Blood and semen samples were collected from total 160 industrial workers exposed to benzene and 200 nonoccupationally exposed control subjects. We investigated macroscopic and microscopic semen parameters in the present study population. Body fluid benzene analysis was done by Head Space chromatography. The sperm DNA integrity was determined by modified alkaline single-cell gel electrophoresis or the comet assay method.

RESULTS

No significant changes were observed in macroscopic semen parameters. A duration-dependent decrement in total sperm count and the percentage of motility was observed among the benzene-exposed industrial workers (p<0.05). A duration-dependent increment of abnormal sperm morphology was observed among the benzene-exposed industrial workers (p<0.01). A significant increase in comet tail length was observed in the exposed groups (p<0.01) in comparison to the controls. In regression analysis, the data were observed to be significant at the level of p<0.05 for Group II industrial workers (t=2.301).

CONCLUSION

Sperm integrity is considered one of the major factors in male infertility. The sperm DNA damage is an important step from spermatogenesis to malfunctions such as infertility; therefore, the present study represents an important evaluation for correctly diagnosing the problem, precisely from the level of DNA itself.