Healthcare Providers' knowledge, attitudes and practice in relation to drug hypersensitivity reactions at King Abdulaziz Medical City in Riyadh

Background

Drug hypersensitivity reactions (DHRs) are immune-mediated responses triggered by exposure to a drug. DHRs are responsible for serious adverse drug reactions (ADRs) and are considered the fifth leading cause of death. This study aims to assess and evaluate the knowledge, practice, and attitudes of healthcare providers (HCPs) towards DHRs.

Methods

A cross-sectional survey was conducted at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. Healthcare providers, including pharmacists, physicians, and nurses, were recruited using a convenience sampling method to complete the survey. The survey comprised three domains: knowledge (14 items), attitudes (5 items), and practices (6 items), utilizing a standardized self-administered questionnaire.

Results

The survey was completed by 373 healthcare providers. The respondents were predominantly female (72.1 %) with a mean age of 33.8 ± 7.8 years. Of the respondents, 64 % were nurses, 25 % pharmacists, and 11.3 % physicians. Educational levels varied, with 53 % holding a bachelor's degree, 22 % an associate degree, and 25 % a master's degree or higher. The median knowledge score was 48. Female healthcare providers, those with advanced levels of education, and physicians had higher knowledge scores compared to male and nurse participants (p < 0.05). One-third of the respondents (33 %) were satisfied with their knowledge of DHRs, and 42 % believed HCPs should receive more advanced training in DHR management. Less than a quarter of HCPs reported inquiring about patients' histories of hypersensitivity reactions.

Conclusions

The study revealed that healthcare workers had a relatively low level of knowledge about drug hypersensitivity reactions and lacked a consensus on DHR management. While displaying a positive attitude towards DHRs, they often did not translate this attitude into consistent clinical practice.

Development of WHO Recommendations for the Final Phase of Elimination and Prevention of Re-Establishment of Malaria

The WHO recommends that all affected countries work toward the elimination of malaria, even those still experiencing a high burden of disease. However, malaria programs in the final phase of elimination or those working to prevent re-establishment of transmission after elimination could benefit from specific evidence-based recommendations for these settings as part of comprehensive and quality-controlled malaria guidelines. The WHO convened an external guideline development group to formulate recommendations for interventions to reduce or prevent malaria transmission in areas with very low- to low-transmission levels and those that have eliminated malaria. In addition, several interventions that could be deployed in higher burden areas to accelerate elimination, such as mass drug administration, were reviewed. Systematic reviews were conducted that synthesized and evaluated evidence for the benefits and harms of public health interventions and summarized critical contextual factors from a health systems perspective. A total of 12 recommendations were developed, with five related to mass interventions that could be deployed at higher transmission levels and seven that would be most appropriate for programs in areas close to elimination or those working to prevent re-establishment of transmission. Four chemoprevention, two active case detection, and one vector control interventions were positively recommended, whereas two chemoprevention and three active case detection interventions were not recommended by the WHO. None of the recommendations were classified as strong given the limited and low-quality evidence base. Approaches to conducting higher quality research in very low- to low-transmission settings to improve the strength of WHO recommendations are discussed.

Analyzing and comparing the effectiveness of malware detection: A study of machine learning approaches

The Internet has become a vital source of knowledge and communication in recent times. Continuous technological advancements have changed the way businesses operate, and everyone today lives in the digital world of engineering. Because of the Internet of Things (IoT) and its applications, people's impressions of the information revolution have improved. Malware detection and categorization are becoming more of a problem in the cybersecurity world. As a result, strong security on the Internet could protect billions of internet users from harmful behavior. In malware detection and classification techniques, several types of deep learning models are used; however, they still have limitations. This study will explore malware detection and classification elements using modern machine learning (ML) approaches, including K-Nearest Neighbors (KNN), Extra Tree (ET), Random Forest (RF), Logistic Regression (LR), Decision Tree (DT), and neural network Multilayer Perceptron (nnMLP). The proposed study uses the publicly available dataset UNSWNB15. In our proposed work, we applied the feature encoding method to convert our dataset into purely numeric values. After that, we applied a feature selection method named Term Frequency-Inverse Document Frequency (TFIDF) based on entropy for the best feature selection. The dataset is then balanced and provided to the ML models for classification. The study concludes that Random Forest, out of all tested ML models, yielded the best accuracy of 97.68 %.

Prevalence of Hemorrhoids and the Associated Risk Factors Among the General Adult Population in Makkah, Saudi Arabia

INTRODUCTION

Hemorrhoidal disease is one of the most common benign anorectal conditions. It is described as the symptomatic enlargement and abnormally downward displacement of anal cushions. Its effect on the quality of life of patients is significantly negative and is considered one of the leading causes of lower gastrointestinal bleeding. However, studies that determine the prevalence of and risk factors associated with hemorrhoidal disease are limited. Therefore, this study aimed to evaluate the prevalence of and risk factors for hemorrhoids among the general adult population in the city of Makkah, Saudi Arabia.

METHODS

A descriptive cross-sectional study was conducted with a structured, prevalidated questionnaire and was used with some modifications. It was created using Google Forms (Google, Mountain View, CA) and distributed via social media platforms in Arabic along with the English version of each question. All data from the returned survey were encrypted. IBM SPSS Statistics, version 21 (IBM Corp., Armonk, NY) was used to analyze the data.

RESULTS

A total of 400 participants completed the study questionnaire. Regarding the prevalence of hemorrhoids among the general population in Makkah, 64 participants (16%) reported that they were diagnosed with hemorrhoid disorder. The most reported symptoms among participants with hemorrhoids were pain with defecation (76.2%), discomfort (63.5%), and swelling (55.6%).

CONCLUSION

Hemorrhoids are one of the most common complaints among surgical patients and are more prevalent in men. The risk of hemorrhoids is significantly higher in married women with a history of pregnancy, who are overweight, and who consume low-fiber diets. It is better to practice close follow-up of patients with hemorrhoids to avoid complications, particularly, patients with chronic diseases who are at a high risk.

Perception and attitude of type 2 diabetic patients toward insulin therapy in the primary care of National Guard for Health Affairs (NGHA) in Jeddah, Saudi Arabia

Purpose/Background

Our study explores and determines the perception toward insulin among patients with diabetes in the National Guard for Health Affairs (NGHA), Jeddah, the Kingdom of Saudi Arabia (KSA), and aims to gain insight into the causes of refusal. Patients with type 2 diabetes (T2D) are likely to need the use of insulin to keep blood glucose levels within normal range and delay the onset of diabetes-related problems. Individuals with diabetes may be hesitant to begin insulin therapy if they have a negative attitude toward it, which might add to the delay in beginning treatment.

Materials and Methods

A cross-sectional study was conducted in the primary healthcare centers of the NGHA in Jeddah, Saudi Arabia. Data were collected through a validated self-administered questionnaire that was divided into three sections, with a total of 32 questions. The first section concerned demographic data, the second part was directed toward insulin users, and the last section was directed toward non-insulin patients.

Results and Conclusion

Our study collected 314 responses. Males constituted 54.8% of participants and insulin users resembled 45.7%. According to our study, important deterrents to starting insulin therapy among non-insulin users included the following: the cost of insulin, the pain associated with injections, the difficulty in maintaining food control while on insulin treatment, scarring at the injection site, and the weight gain impact. Factors that were found to influence compliance to insulin therapy among insulin users included fear of weight gain and self-administration of insulin.

The Electric Field Induced by a Microcoil During Magnetic Stimulation

OBJECTIVE

The purpose of this study is to calculate the electric field produced by an implanted microcoil during magnetic stimulation of the brain.

METHODS

The electric field of a microcoil was calculated numerically.

RESULTS

The maximum value of the induced electric field is approximately 0.000026 V/m for a 1 mA, 3 kHz current passed through the coil.

CONCLUSION

This electric field value is too small to cause neural stimulation.

SIGNIFICANCE

Previous studies reporting magnetic stimulation using a microcoil must have been exciting neurons by some other mechanism.

Retrospective evaluation of LCP-tacrolimus (Envarsus XR) dosing in de novo kidney transplant

INTRODUCTION

Tacrolimus is known to exhibit significant inter- and intra-patient pharmacokinetic (PK) and pharmacodynamic (PD) variability regarding therapeutic response. LCP-tacrolimus (LCPT-Envarsus XR) was approved in 2018 for use as a de novo immunosuppressive agent in kidney transplants, but there is limited evidence to guide de novo dosing of LCPT in patients with obesity. The primary objective of this study was to evaluate the impact of different calculated weight-based de novo LCPT dosing on early transplant outcomes.

METHODS

This was a retrospective study of patients with obesity (BMI ≥ 30 kg/m2 ) who received a kidney transplant at the University of Illinois Hospital and Health System (UIH), between March 2019 and March 2021. Subjects were included if were age 18 years or older and received de novo LCPT throughout index hospitalization. The primary endpoint of this study was to compare correlations between the first tacrolimus trough level and dosing weight strategy (e.g., TBW, AdjBW, IBW).

RESULTS

There was a statistically significant, though modest, correlation between all three dosing strategies and the first tacrolimus trough level (TBW correlation coefficient = .431, p < .001; AdjBW correlation coefficient = .455, p < .001; IBW correlation coefficient = .465; p < .001). In regression modeling for supratherapeutic levels each additional .01 mg/kg increase in dose by TBW, AdjBW, and IBW increased the odds of a supratherapeutic level by 1.46, 1.34, and 1.24, respectively (p < .001).

CONCLUSIONS

The use of LCPT in kidney transplant recipients with obesity dosed using TBW demonstrated the strongest correlation with initial supratherapeutic tacrolimus levels. Larger prospective studies are needed to investigate the further impact of body weight on dosing regimens in the obese population.

Is Arabic Information on YouTube About Erectile Dysfunction Based on Scientific Evidence?

Background

Online medical education is critical for public health literacy and physician efficacy, but it must be trustworthy. Although it has the potential to be a useful resource for medical education, users must be able to identify reliable content.

Objective

To assess the scientific quality of Arabic-language video content related to erectile dysfunction that is available on YouTube to learn what information our patients can handle online.

Materials and Methods

A comprehensive search of the YouTube database was carried out to identify videos related to erectile dysfunction published in Arabic. The search was conducted using the following keywords: "Erectile dysfunction", "Sexual dysfunction" and "Impotence". Without a time, limit, the search was carried out until January 1, 2023. The quality assessment of the videos was done using the Kappa score.

Results

The videos in our sample had up to one million views (average 2,627,485.6), and the kappa index was 0.86 (p <0.001). Of these videos, 16% were considered scientific evidence-based (SEB), and 84% were considered not scientific evidence-based (NSEB) (p <0.001). The NSEB group addressed details concerning natural remedies, the Psychosocial sphere, and lifestyle, whereas the SEB group tended to be more concerned with physiopathology, etiology, endothelial dysfunction, diagnosis, psychosocial treatment, oral treatment, injections, or prosthesis.

Conclusion

On social media, misleading or incorrect information about erectile dysfunction is widely disseminated. This research may support urological and technical oversight and emphasizes guiding patients to the best men's health options.

Self-reported depression and anxiety rates among females with cutaneous leishmaniasis in Hubuna, Saudi Arabia

Background

Cutaneous leishmaniasis (CL) is a parasitic disease transmitted through the bite of infected sandflies, causing disfiguring skin lesions and a range of physical symptoms. However, the psychological impact of CL is often overlooked despite the significant burden it imposes on the affected individuals and communities. This is especially true in Saudi Arabia, where limited research exists on the psychological consequences of CL, particularly among females. This study aimed to address this knowledge gap by investigating the perceived psychological problems associated with CL among females living in the Hubuna area of Saudi Arabia.

Methods

This cross-sectional study recruited 213 females with CL in the Hubuna area of Saudi Arabia using purposive sampling. Data was collected using a self-administered electronic questionnaire that included socio-demographic characteristics and measures of depression and anxiety using the BDI and GAD-7 tools. Descriptive analysis was used to determine the psychological impact of CL, including means and standard deviations for the BDI and GAD-7 scores, as well as frequencies and percentages for other variables of interest. Logistic regression was performed to identify independent predictors of anxiety and depression, including variables such as age, marital status, education, occupation, number and location of lesions. The significance level for all statistical tests was set at p < 0.05. The study was carried out between September and December of 2022.

Results

The study found that the mean Beck Depression Inventory (BDI) and Generalized Anxiety Disorder-7 (GAD-7) scores among the participants were 8.67 ± 4.82 out of 63 and 8.20 ± 7.08 out of 21, respectively. Furthermore, the prevalence of depression and anxiety was 55.9% and 68.1%, respectively, indicating a significant psychological burden associated with CL in the study population. The results of the logistic regression analysis showed that anxiety and depression were significantly associated with age, marital status, number of lesions, and location of the lesions on the body, highlighting the importance of considering these factors when designing interventions aimed at improving the mental health of CL patients.

Conclusions

In conclusion, this study highlights the significant psychological impact of CL among females in the Hubuna area of Saudi Arabia, calling for urgent action to address this neglected aspect of the disease. By integrating mental health considerations into CL prevention and management efforts, healthcare providers can improve the overall well-being of affected individuals and contribute to the broader goal of eliminating CL as a public health concern.

The Modified Bosniak Classification for Intermediate and High-Risk Renal Cysts

Background Renal cysts are uncommon among the pediatric population, and their transformation into malignant lesions is also uncommon. Early detection can prevent further complications and protect renal function. Bosniak classification is a computed tomography-based classification for renal cysts developed for adults. Children are more susceptible to CT radiation. Therefore, a modified Bosniak classification for children based on the ultrasound (US) can be used if it shows reliability and accuracy. Aim To apply the modified Bosniak classification system among children with renal cysts. Methods This was a retrospective study that was conducted on pediatric patients who underwent surgery for intermediate and high-risk complex renal cysts in Prince Sultan Military Medical City, Riyadh, Saudi Arabia using radiological information from 2009 to 2022. The collected data included demographics, medical history, radiological findings, and characteristics of renal cysts. SPSS Statistics v. 22 (IBM Corp., Armonk, NY) was used to analyze the data. Results There were 40 children included in the study based on the US-modified Bosniak classification. Around 26.3% of patients had class I and 39.5% had class II renal cysts. Histopathology showed that 10% had Wilms tumor, and 15% had benign lesions. There were significant correlations between pathology findings and US findings (p=0.004), and CT findings (p=0.016). Conclusion The modified Bosniak classification based on the US is sensitive, specific, and sufficiently accurate in the classification of renal cysts among children. Also, the size of the renal cysts can be a diagnostic marker of differentiation of benign and malignant cysts with high sensitivity and specificity.

Correlation between biographic profile and compliance to key performance indicators (KPI) for infection control among healthcare workers in Saudi Arabia: A cross-sectional study

Objective: To find out how well Saudi Arabian healthcare workers followed infection control guidelines and determine whether there is a any relationship between the biographic profile of healthcare staff and their degree of compliance with infection control. Methodology: This descriptive-correlation study was conducted on healthcare workers from different Saudi Arabian hospitals. The study used a three-point Likert scale, and the rating scales used were “3” to indicate always, “2” to indicate sometimes, while “1” was used to indicate never. Results: Of 180 respondents, 62.8% were young adults, 73.3% were males, 68.3% were doctoral degree holders, 66.1% were licensed medical doctors, and 39.4% were advanced beginners. Saudi healthcare workers had an overall level of “high compliance” (mean=2.29). Chi-square test of independence (r2) revealed a statistically significant relationship between compliance to infection control practices and the following variables: age (p=0.0100), gender (p=0.0177), educational attainment (p=0.0001), and profession (p<0.0001). Conclusion: In Saudi Arabia, healthcare staff generally follow infection control procedures. Moreover, biographic profiles were significantly associated with the degree of infection prevention practice compliance by healthcare staff.

Psychometric properties of the Arabic version of the anxiety inventory for respiratory disease in patients with COPD

PURPOSE

The Anxiety Inventory for Respiratory Disease (AIR) is a reliable and valid scale for examining the anxiety in patients with COPD. This study aimed to cross-culturally adapt and translate the original AIR scale into the Arabic language and to examine its reliability and validity in Arab patients with COPD.

MATERIAL AND METHODS

This was a validation study conducted on 70 Arabic patients with COPD. The AIR-A and the Hospital Anxiety and Depression Scale (HADS) were completed on the first assessment. After two weeks, 55 patients completed the AIR-A scale again. The reliability was assessed by Cronbach's α and intraclass correlation coefficients (ICC_2,1). Exploratory factor analysis (EFA), and the confirmatory factor analysis (CFA) were used to measure the structural validity. The construct validity was also explored.

RESULTS

The AIR-A questionnaire had a Cronbach's α of 0.91 and ICC_2,1 of 0.86. The EFA revealed that the AIR-A was unidimensional. The CFA showed the single-factor model required minor modifications to reach the best fit. The AIR-A was correlated with the HADS- anxiety (r = 0.89, p < 0.001).

CONCLUSION

The Arabic version of AIR scale is reliable, and valid for assessing the anxiety disorder in Arabic speaking patients with COPD worldwide.Implications for PracticeThe Arabic version of AIR will be useful for examining anxiety in Arabic speaking patients with COPD worldwide.The Arabic version of AIR will help clinicians to monitor the effect of interventions in Arabic speaking patients with COPD who suffer from anxiety.The Arabic version of AIR assess only the anxiety.

Epidemiological and molecular description of nosocomial outbreak of COVID-19 Alpha (B.1.1.7) variant in Saudi Arabia

BACKGROUND

Nosocomial outbreaks frequently occurred during the Coronavirus disease 2019 (COVID-19) pandemic; however, sharing experiences on outbreak containment is vital to reduce the related burden in different locations.

OBJECTIVES

This article aims at sharing a practical experience on COVID-19 outbreak containment, including contact tracing, screening of target population, testing including molecular analysis, and preventive modalities. It also provides an epidemiological and molecular analysis of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‑CoV‑2) infection outbreak in a tertiary care hospital in Saudi Arabia.

METHODS

The outbreak occurred in a non-COVID medical ward at a tertiary care hospital in Jeddah, Saudi Arabia, from 22nd March and 15th April 2021. The multidisciplinary outbreak response team performed clinical and epidemiological investigations. Whole-Genome Sequencing (WGS) was implemented on selected isolates for further molecular characterization.

RESULTS

A total of eight nurses (20 % of the assigned ward nurses) and six patients (16.2 % of the ward admitted patients at the time of the outbreak) tested positive for the SARS-CoV-2 virus based on PCR testing. The outbreak investigation identified strong evidence of an epidemiologic link between the affected cases. WGS revealed a set of spike mutations and deletions specific to the Alpha variant (B.1.1.7 lineage). All the nurses had mild symptoms, and the fatality among the patients was 50 % (three out of the six patients).

CONCLUSIONS

The current nosocomial COVID-19 outbreak, caused by the Alpha variant, revealed multiple breaches in the adherence to the hospital infection control recommended measures. Containment strategies were successful in controlling the outbreak and limiting infection spread. Molecular analysis and genome sequencing are essential tools besides epidemiological investigation to inform appropriate actions, especially with emerging pathogens.

Identification of the novel HLA-DQB1*03:483 allele by sequencing-based typing

A single nucleotide change in exon 1 of HLA-DQB1*03:01:01:03 results in the novel HLA-DQB1*03:483 allele. This article is protected by copyright. All rights reserved.

Clinical Characteristics and Treatment Outcomes of Mild to Moderate Covid-19 Patients in Saudi Arabia: A Single Centre Study

Objective

Since the severity of symptoms affects the treatment option for Coronavirus Disease 2019 (COVID-19) patients, the treatment pattern for mild to moderate non-ICU cases must be evaluated, particularly in the current scenario of mutation and variant strain for effective decision making.

Methods

The objective of retrospective analysis was to assess clinical and treatment outcomes in mild to moderate symptoms in non-ICU patients with COVID-19 who were admitted to major tertiary care hospitals in Al Baha, Saudi Arabia, between April and August 2020.

Results

A total of 811 people were admitted for COVID-19 treatment, age ranging from 14 to 66, diabetes mellitus (31%, n = 248) and hypertension (24%, n = 198) were the most common comorbid conditions. The hydroxychloroquine (HCQ) treated group (G1 n = 466) had an MD of 8 and an IQR of 5–13 for time in hospital with a 4.3% mortality rate, while the non-HCQ group (G2 n = 345) had an MD of 6 and an IQR of 3–11 for time in hospital with a 3.2% mortality rate. A combination of antiviral and antibiotic treatment was found to be effective, other most frequent intervention was analgesics 85.7%, anticoagulant 75%, minerals (Zinc 83% and Vit D3 82%).

Conclusions

The therapy and clinical outcomes from the past will be the guiding factor to treat the COVID variants infection in the future. Patients treated with HCQ had a higher mortality rate, whereas those who were given a non-HCQ combination had a greater clinical outcome profile.

Data Availability

Data available on request due to ethical restrictions. The anonymized data presented in this study are available on request from the corresponding author. The data are not publicly available to maintain privacy and adhere to guidelines of the ethics protocol.

Hyperglycaemic and hypoglycaemic emergencies among patients with diabetes mellitus who participated in pilgrims of the 2019/1440H Hajj season

Background:

Diabetic emergencies are serious acute life-threatening complications of diabetes mellitus (DM). The Hajj season requires the health system in Saudi Arabia to prepare efficiently for the healthcare of millions of pilgrims, particularly for diabetic emergencies. Thus, diabetic emergencies need rapid recognition, diagnosis and treatment. This study aimed to explore the frequency and associated factors of diabetic emergencies among the pilgrim's patients with DM during Hajj, Mecca 2019.

Methods:

This is a prospective study which was conducted on 153 patients with DM. They were selected from three major healthcare-providing facilities during Hajj, which are Arafat, Muzdelefah and Muna healthcare centres. The study was conducted from Aug 5 to 12, 2019. All the patients who presented with any of the hypoglycaemic or hyperglycaemic emergencies had their demographic and clinical characteristics recorded to estimate the prevalence of each emergency and identify its significant associated factors.

Result:

More than 90% of the study participants were patients with type 2 diabetes mellitus (T2DM), while around 7% had type 1 diabetes mellitus (T1DM). Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) and hypoglycaemia were presented in (n = 11, 7.2%), (n = 19, 12.4%) and (n = 28, 18%), respectively, of the participants. Moreover, the study found that “younger age” (odds = 30.4, P = 0.0115) and “type of medication” are significantly associated with DKA. Furthermore, “older age”, “type of medication”, “having Cardiovascular Disease (CVD)” and “diabetes duration” were found to have a significant association with HHS. Moreover, hypoglycaemia was associated with neuropathy complication (odds = 3.54948, P = 0.0187).

Conclusions:

Among the pilgrims with diabetes participating in Hajj, a considerable proportion with a range of diabetic emergencies present to the onsite medical facilities. Preparation is required in terms of logistics and health education about diabetic emergencies to meet the needs of pilgrims with DM, especially those who use insulin and have longstanding diabetes. Further research on DM and the creation of guidelines for health providers and patients with DM during Hajj are important focuses for the future.

Knowledge and attitude toward coronavirus disease 19 pandemic among Saudi Arabia population: A cross-sectional study

BACKGROUND

Coronavirus disease 19 is a pandemic affecting millions worldwide. Since February 2020, new cases are reported in Saudi Arabia, and regulations have been imposed to control the spread of the disease and raise awareness. This study aimed to assess the knowledge and attitudes of the Kingdom's residents toward coronavirus disease 19 during the early stages of the pandemic.

METHOD

A cross-sectional study of 2071 participants who were recruited from various cities in Saudi Arabia. An online questionnaire was shared through social media, which contained questions about demographic data, general knowledge of coronavirus disease 19, and participants' attitudes.

RESULTS

The mean age of the study population was 34 ± 12.4 years. Most of the participants agreed that coronavirus disease 19 is a pandemic and is more serious than seasonal influenza. More than 90% believed that handwashing and social distancing are effective in preventing disease transmission. No significant results were observed when comparing the knowledge of high-risk participants and the normal population. More than half of the cohort were strictly compliant with curfew regulations, handwashing, and face mask. Around 80% of the population is following coronavirus disease 19 news and information through official authorities' press releases.

CONCLUSION

The Kingdom of Saudi Arabia residents showed decent knowledge of coronavirus disease 19. Nevertheless, some information needs emphasizing and proper education. Frequent communication between healthcare authorities and the public is highly recommended.

Association of indoor air pollution on cognitive dysfunction among elderly

OBJECTIVE

Cognitive dysfunction among the elderly is a devastating condition preceded by accumulation of neuropathology leading to accelerated cognitive decline. Many epidemiologic studies have reported the relation between indoor air pollution exposure and cognitive impairment. To clarify the nature of the association, a comprehensive systematic review and meta-analysis were performed.

MATERIALS AND METHODS

The analysis included all observational studies, including cross-sectional studies, prospective and retrospective cohort studies. Experimental studies, randomized controlled trials (RCTs), and controlled clinical trials were excluded. Studies on the relationships of indoor air pollution and cognition published before 30 April 2021 which are peer-reviewed scientific publications available in English were included after performing a structured literature search through electronic databases, including PubMed, Embase, Cochrane Library, and clinical trial.gov. A total of 146 articles were collected, and after screening thoroughly only, 9 studies were selected. Meta-analysis for the final set of selected studies was performed using the R software.

RESULTS

The quality of all the studies was adequate as almost all reported an association between at least one pollutant and cognitive dysfunction. However, relatively few studies considered outcomes that provide the most substantial evidence for a causal effect. In total, 5 studies have reported on cognitive function. The pooled mean of cognitive function was 12.16 (95% CI: 10.73 to 13.58). However, the heterogeneity was very high (I2=100%; chi-square test for heterogeneity = p<0.001). We used a modified JBI structured risk of the bias assessment tool, and it was minimal among the included studies as most of the studies have followed a random sampling method and explicitly mention it in their methods.

CONCLUSIONS

Exposure to indoor air pollution through fuels used for cooking and heating was significantly associated with cognitive dysfunction among elderly women. Given the limitations, a more extensive meta-analysis and longitudinal studies are recommended to investigate the biological mechanism behind the impact of indoor air pollution on cognitive health.

Lack of Zika Virus and Other Recognized Flaviviruses among the Mosquito Vectors during and Post the Hajj Mass Gathering

Makkah city, Kingdom of Saudi Arabia (KSA), contains many of the world’s mosquito vectors of parasitic and arboviral disease and is the site of the Hajj mass gathering. As such there is a risk of exportation and globalization of vector-borne viruses, including the re-emerging Zika virus (ZIKV). There was international concern regarding the introduction of ZIKV to KSA and potential international spread of the virus following the 2016 Hajj which took place few days after the Rio summer Olympics at the height of the ZIKV pandemic. We aimed to detect flaviviruses, including ZIKV, circulating among mosquito hosts in the city of Makkah during and post the 2016 Hajj pilgrimage. Mosquitos (adults and larvae) were sampled from 15 sites in Makkah city during and post the 2016 Hajj and identified to species by morphological keys. Mosquitos were pooled according to date of collection, location, and species. A Pan-Flaviviruses RT-PCR assay that enables identification of 51 flaviviruses species and three tentative species was used to detect flavivirus RNA directly from mosquito homogenates. Between the 10 September and 6 October 2016, 9412 female mosquitos were collected. Of these, 81.3% were Aedes aegypti, 18.6% were Culex species, and 0.1% were Anopheles species. Of the total 493 mosquito pools generated, 242 (49%) were positive by the Pan-Flaviviruses primer set. Sequence analysis revealed that none of the mosquitos carried a pathogenic flavivirus, including ZIKV, but were infected with a novel insect-specific flavivirus. We found no pathogenic flaviviruses circulating in Makkah city during and post the 2016 Hajj and no evidence of introduction of ZIKV through the pilgrimage. Enhanced vector-borne diseases surveillance, prevention, and control are crucial in KSA especially during international mass gatherings such as the annual Hajj to prevent outbreaks and the spread of viruses with epidemic and pandemic potentials.

Knowledge and Awareness of Authorship Practices Among Health Science Students: A Cross-Sectional Study

BACKGROUND

The International Committee of Medical Journal Editors has published clear guidelines on the authorship of scientific papers. It is the research team's responsibility to review and ensure those guidelines are met. Authorship ethics and practices have been examined among healthcare professionals or among particular health science students such as medical students. However, there is limited evidence to assess the knowledge of authorship roles and practices among health science students.

METHODS

We conducted a cross-sectional study to assess the knowledge of authorship guidelines practices among health science students at King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A survey was developed and distributed. It covered several domains, including demographic characteristics, participant's knowledge and attitude of authorship practices, knowledge and experience with ghost and guest authorships, and knowledge of institutional authorship policies. Moreover, a score was computed to reflect the respondents' knowledge about authorship practices.

RESULTS

Among the 321 participants who agreed to take the survey, two-thirds agreed with and supported that multi-authored articles' credit allocation should be based on the most significant contribution and contributions to the manuscript writing. Almost 47% agreed that team relationships would influence authorship allocation. The majority of the participants were not aware of their institutional research and publication policies. Also, around 50% of participants were not aware of guest or ghost authorships. Finally, the knowledge score about authorship credits, allocation, contribution, order, and guidelines was higher among students who were assigned as corresponding authors and those who were aware of their institutional authorship guidelines and policies.

CONCLUSION

In conclusion, our findings suggest that health science students may have limited knowledge about authorship guidelines and unethical behaviors involved in a scientific publication. Universities and research centers should make more efforts to raise the awareness of health science students regarding authorship guidelines while ensuring that they comply with those guidelines.

Recurrent Mixed Neuroendocrine-Non-Neuroendocrine Neoplasm in the Gallbladder: A Case Report

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) of the gallbladder are rare with no established therapeutic strategies. We report a case of recurrent gallbladder MiNEN from a population with a low incidence of gallbladder carcinomas, a review of the current therapeutic options, and recent updates on the nomenclature proposed by the World Health Organization in 2017.

A245 IGG4- RELATED DISEASE AS A RARE CAUSE OF GASTRIC OUTLET OBSTRUCTION: A CASE REPORT AND LITERATURE REVIEW

Background

IgG4- related disease (IgG4-RD) is a newly recognized systemic fibroinflammatory condition that can affect a wide range of organs, including the pancreas, biliary system, retroperitoneum, lymph nodes and salivary glands. However, gastrointestinal luminal involvement is very rare, and the presentation with isolated gastrointestinal obstruction is extremely unusual.

Aims

We present a case of IgG4-RD presenting with gastric outlet obstruction secondary to severe duodenal stricture.

Methods

A 59-year-old female presented with 6 months history of abdominal pain, postprandial nausea and vomiting associated with significant weight loss. CT showed circumferential wall thickening of the 2ndand 3rd parts of the duodenum with gastroscopy showing severe ulcerated duodenal stricture that could not be passed through. Biopsies from the ulcerated area did not reveal a specific etiology, but malignancy could not be excluded, and the decision was made to pursue surgical management with Whipple’s procedure.

Surgical pathology revealed IgG4 related disease in the form of an ulcerated gastric mass invading the duodenum and the pancreas with normal serum IgG4 level. Postoperatively, the patient developed anastomotic leak that was managed conservatively with antibiotics and drainage resulting in significant improvement in her symptoms. MRCP did not show any pancreatic or biliary abnormalities.

Results

A few weeks later, she represented with abdominal pain as well as nausea and vomiting. CT scan revealed severe inflammatory changes at the anastomosis site with mucosal thickening concerning for persistent leak. However, as she was optimally treated before, it was concluded that these changes are likely related to recurrent IgG4-RD. To induce remission, prednisone was started with remarkable improvement in her symptoms within two weeks, and complete resolution of the previous inflammatory changes around the anastomosis on repeat imaging. Subsequently, she was started on mycophenolate mofetil (MMF) with a slow prednisone taper.

Conclusions

IgG4-RD involving the gastrointestinal tract is rare with rare cases reported in the literature presenting in variable ways. Our case demonstrates the possibility of IgG4-RD presenting as gastric outlet obstruction; IgG4-RD should be considered in the differential diagnosis of unexplained duodenal stricture or gastric outlet obstruction. IgG4-RD usually responds to steroids but long-term response rates to steroid-sparing agents, especially in the subset of patients with luminal IgG4-RD, remains to be seen.

Funding Agencies

None

Kelch 13-propeller polymorphisms in Plasmodium falciparum from Jazan region, southwest Saudi Arabia

BACKGROUND

Artemisinin-based combination therapy (ACT) is recommended at the initial phase for treatment of Plasmodium falciparum, to reduce morbidity and mortality in all countries where malaria is endemic. Polymorphism in portions of P. falciparum gene encoding kelch (K13)-propeller domains is associated with delayed parasite clearance after ACT. Of about 124 different non-synonymous mutations, 46 have been identified in Southeast Asia (SEA), 62 in sub-Saharan Africa (SSA) and 16 in both the regions. This is the first study designed to analyse the prevalence of polymorphism in the P. falciparum k13-propeller domain in the Jazan region of southwest Saudi Arabia, where malaria is endemic.

METHODS

One-hundred and forty P. falciparum samples were collected from Jazan region of southwest Saudi Arabia at three different times: 20 samples in 2011, 40 samples in 2016 and 80 samples in 2020 after the implementation of ACT. Plasmodium falciparum kelch13 (k13) gene DNA was extracted, amplified, sequenced, and analysed using a basic local alignment search tool (BLAST).

RESULTS

This study obtained 51 non-synonymous (NS) mutations in three time groups, divided as follows: 6 single nucleotide polymorphisms (SNPs) '11.8%' in samples collected in 2011 only, 3 (5.9%) in 2011and 2016, 5 (9.8%) in 2011 and 2020, 5 (9.8%) in 2016 only, 8 (15.7%) in 2016 and 2020, 14 (27.5%) in 2020 and 10 (19.6%) in all the groups. The BLAST revealed that the 2011 isolates were genetically closer to African isolates (53.3%) than Asian ones (46.7%). Interestingly, this proportion changed completely in 2020, to become closer to Asian isolates (81.6%) than to African ones (18.4%).

CONCLUSIONS

Despite the diversity of the identified mutations in the k13-propeller gene, these data did not report widespread artemisinin-resistant polymorphisms in the Jazan region where these samples were collected. Such a process would be expected to increase frequencies of mutations associated with the resistance of ACT.

Congenital Factor VII Deficiency in Association With Bicuspid Aortic Valve and Multicystic Dysplastic Kidney Disease in a Child

Congenital factor VII deficiency is a rare bleeding disorder, with an incidence of 1:500,000. This case report describes an exceptionally unusual combination of congenital factor VII deficiency, multicystic dysplastic kidney disease and bicuspid aortic valve disease, in the same patient.

The Perception of Medical Students at King Abdulaziz University Hospital Regarding the Liver Transplant Allocation System

Background: The benefit of liver transplantation is not only to increase the patient’s lifetime but also for persistent relief of pain and anxiety. Shortage of the organ is the main hindrance of transplantation around the world, leading authorities to pass a general law for the reasonable distribution of organs and come up with the Model for End-Stage Liver Disease (MELD) system which scores the severity of liver disease and risk of mortality in order to detect the mechanism of allocation. 

Objective: This study aims to assess medical students’ perception of the liver transplant and allocation system.

Methods: A cross-sectional survey was carried out among 402 medical students at King Abdulaziz University in Jeddah, Saudi Arabia.

Results: The majority of the medical students (84.4%) believed that a successful liver transplant improves both lifetime and quality of life. Most of the students also saw that the minimum survival rate should be five years after transplantation and that the patient should recover to be at least ambulatory, even if restricted by strenuous physical activity. When asked whether urgency or prospect of success defined a successful transplant, most of the students who chose urgency were preclinical (50.7%), while the prospect of success was the dominant answer chosen by students in their clinical years of study (66.1%).

Conclusion: The criteria determining the success of a liver transplant include a gain in both lifetime and quality of life. The majority of respondents wanted the capacity to benefit to be considered in the liver allocation system.

Herpes Zoster Eruption in an Otherwise Healthy Child: A Case Report

Varicella-zoster virus (VZV; human herpesvirus 3) is a herpesvirus that causes infection in humans. The reactivation of latent VZV manifests as herpes zoster or shingles. In immunocompetent children, reactivation is rare, as increasing age is the most common risk factor for reactivation. The complications of infection include post-herpetic neuralgia and neurological sequelae as well as a bacterial infection of the crusted skin. We present a case of an otherwise healthy 13-year-old child with herpes zoster and multiple risk factors, who was managed successfully, in order to expand the limited literature. The patient presented with a painful vesicular rash, which appeared as multiple grouped vesicles on an erythematous base spreading over the right half of the face. The diagnosis of herpetic (varicella) vesiculobullous dermatitis was confirmed by biopsy and the patient was started on acyclovir and clindamycin with gradual improvement and resolution of his symptoms. Reactivation of VZV is considered a consequence of decreased cell-mediated immunity. However, the reason for reactivation in immunocompetent children remains unclear. In the present case, the patient may have become exposed in utero, through vaccination, or as a result of major facial trauma sustained at the age of six years.

Effect of the thymine-DNA glycosylase rs4135050 variant on Saudi smoker population

Background

Thymine‐DNA glycosylase (TDG) is an essential DNA‐repair enzyme which works in both epigenetic regulation and genome maintenance. It is also responsible for efficient correction of multiple endogenous DNA lesions which occur commonly in mammalian genomes. Research of genetic variants such as SNPs, resulting in disease, is predicted to yield clinical advancements through the identification of sensitive genetic markers and the development of disease prevention and therapy. To that end, the main objective of the present study is to identify the possible interactions between cigarette smoking and the rs4135050 variant of the TDG gene, situated in the intron position, among Saudi individuals.

Methods

TDG rs4135050 (A/T) was investigated by genotyping 239, and 235 blood specimens were obtained from nonsmokers and smokers of cigarette respectively.

Results

T allele frequency was found which showed a significant protective effect on Saudi male smokers (OR = 0.64, p = 0.0187) compared to nonsmoking subjects, but not in female smokers. Furthermore, smokers aged less than 29 years, the AT and AT+TT genotypes decreased more than four times the risk of initiation of smoking related‐diseases compare to the ancestral AA homozygous genotype. Paradoxically, the AT (OR = 3.88, p = 0.0169) and AT+TT (OR = 2.86, p = 0.0420) genotypes were present at a higher frequency in smoking patients aged more than 29 years as compared to nonsmokers at the same ages.

Conclusion

Depending on the gender and age of patients, TDG rs4135050 may provide a novel biomarker for the early diagnosis and prevention of several diseases caused by cigarette smoking.

Practices, awareness and attitudes toward self-medication of analgesics among health sciences students in Riyadh, Saudi Arabia

BACKGROUND

Self-medication is a common practice among health sciences students in Saudi Arabia. It is known that inappropriate selfmedication may harm individuals due to increasing the risk of drug misuse or delaying a hospital visit by masking some symptoms. Thus, the aim of our study is to investigate and assess practices, awareness and attitudes toward analgesics self-medication among health science students in Riyadh, Saudi Arabia.

METHODS

This is a cross-sectional study in a form of electronic survey that was conducted among health sciences students from different universities in Riyadh, Saudi Arabia in 2016. Two hundred and seventy-two students responded to the questionnaire. The electronic questionnaire survey covered demographics, self-medication practice and the analgesics consumption, attitude and awareness about the safety of self-medication practice of analgesics.

RESULTS

Factors associated with high prevalence of self-medication were not significant except for age (P = 0.04). Health sciences students had adequate knowledge about the safety of analgesics consumption itself and simultaneous use of analgesics with other drugs, significantly different by college; 80% for Pharmacy, 71% for Medicine, 61% for Nursing and Dentistry, and 25% for Applied Medical Sciences and pre-professional students (p = 0.037).

CONCLUSION

The occurrence of self-medication practices is distressingly high among health sciences students. It is necessary to educate the students about the side effects and drawbacks of irresponsible selfmedication.

Virtual Crossmatch: Reality of Perception

Results of 773 actual flow crossmatches (aFXMs) and virtual flow crossmatches (vFXMs) performed for living and deceased donor kidney transplantation in our center were analyzed retrospectively and evaluated for their concordance. Prediction of vFXMs was based on antibody identification using single antigen bead assay and locally established mean fluorescence intensity cutoff point compared with donor HLA antigens. The vast majority of aFXMs were in concordance with vFXMs with an overall concordance of 97%. Twenty-three predicted to be negative showed positive aFXMs; 12 of them had 0% calculated panel-reactive antibody, and 11 were found in patients with multiple non-donor-specific HLA antibodies. Three predicted positive vFXMs yielded negative aFXMs; 2 of them had allele-specific antibodies. CONCLUSIONS: vFXMs based on precise characterization of antibody specificities detected by single antigen bead assay using our cutoff point accurately predicted FXMs in the majority of patients and can be used safely to allocate kidney offers without performing physical crossmatches in selected patients.

Seroprevalence of dengue fever and the associated sociodemographic, clinical, and environmental factors in Makkah, Madinah, Jeddah, and Jizan, Kingdom of Saudi Arabia

This study aimed to estimate the seroprevalence of anti-dengue IgG antibodies in Makkah, Al Madinah, Jeddah, and Jizan; and to identify the associated demographic, clinical, and environmental independent risk factors. A community-based household serosurvey conducted between September 20, 2016 and January 31, 2017. A multi-stage stratified cluster sampling was used to select 6596 participants from Makkah, Madinah, Jeddah, and Jizan. Blood samples were drawn from all participants to detect anti-dengue IgG antibodies. A semi-structured questionnaire was used to collect information on demographic, clinical, and environmental data. Multivariate logistic regression was carried out to identify independent risk factors of dengue seropositivity. The dengue seroprevalence (95% confidence intervalI) was 26.7% (25.6%, 27.8%), with the highest (33.6%) and lowest (14.8%) rates in Jizan and Madinah, respectively, and reaching 50% or more in several districts of the four cities. Demographic predictors of seroprevalence included: dwelling in Makkah (odds ratio [OR] = 2.19, p < 0.001) or Jizan (OR = 2.17, p < 0.001); older age (OR = 3.91, p < 0.001 for age>30 years); housing type (OR = 1.84 and 1.82, p < 0.001 for popular and social houses, respectively); and number of household occupants (OR = 0.86 and 0.71 for 6-10 [p = 0.042] and 11-20 [p = 0.002] occupants, respectively). Environmental predictors included the absence of pest control works in residency area (OR = 1.39, p = 0.002), presence of mosquitoes in the home (OR = 1.39, p = 0.001), and absence of awareness campaigns (OR = 1.97, p < 0.001). One in four inhabitants of the Western region of Saudi Arabia was seropositive for the dengue virus. Implementation of behavior-based educational programs is recommended, involving the population in the identification and eradication of vector sources and promoting appropriate behaviors that prevent the spread.

Risk Factors Associated with Trastuzumab-induced Cardiotoxicity in Patients with Human Epidermal Growth Factor Receptor 2-positive Breast Cancer

Context:

Although trastuzumab is a highly effective and selective targeted therapy for human epidermal growth factor receptor 2 (HER2)-positive breast cancer, the drug-induced cardiotoxicity may confine its usefulness in patients.

Aim:

To explore risk factors associated with the development of cardiotoxicity in patients with HER2-positive breast cancer.

Settings and Design:

A retrospective review of medical records and chart review for all patients with breast cancer treated with trastuzumab was conducted at King Abdulaziz Medical City and King Abdullah Specialized Children Hospital in Riyadh, Kingdom of Saudi Arabia, between October 2015 and February 2018. Patients with declined left ventricular ejection fraction, either with or without cardiac symptoms, were recognized as those with cardiotoxicity due to trastuzumab administration.

Results:

A total of 146 patients were included in the study with an average age of 52.7 (standard deviation = 12.2) years. Thirty-two (21.9%) patients developed cardiotoxicity. However, only 24 (16.4%) were symptomatic with an apparent heart failure but it did not necessitate interruption of trastuzumab therapy. The majority of patients had prior underlying cardiovascular diseases. This study identified unilateral tumor site (62.5%), breast surgery (37.5%), and concomitant taxane chemotherapy (62.5%) as the main risk factors associated with significant increase in cardiotoxicity in patients with breast cancer (with P values of 0.0269, 0.0482, and 0.0225, respectively).

Conclusion:

The majority of patients (more than 90%) developed cardiotoxicity after completion of chemotherapy. However, recruiting a larger sample size should be warranted to confirm or negate these findings.

The prevalence of CCR5-Δ32 mutation in a cohort of Saudi stem cell donors

CCR5 is a chemokine receptor that was found to be used by HIV as a co-receptor for entering target cells. A 32 bp deletion was described in certain people that rendered CCR5 non-functional. The mutant allele CCR5-Δ32 has been shown to prevent HIV infection. In addition, stem cell transplantation with the CCR5-Δ32 homozygous genotype can lead to clearance of HIV infection. In this study, our aim was to investigate the frequency of CCR5-Δ32 mutation in a cohort of stem cell donors from cord blood bank and stem cell donor registry. A total of 3025 samples were collected from healthy stem cell donors (2625) and from cord blood units (400). DNA was extracted and the CCR5 gene was amplified by polymerase chain reaction (PCR) in a light cycler system using SYBR Green dye. The mutated gene was further confirmed by direct gene sequencing. We found 38 heterozygous for CCR5-Δ32 and one homozygous CCR5 mutation (Δ32/Δ32) out of the 3025 tested individuals. We conclude that the protective CCR5-Δ32 allele appears to be rarely present in Saudi Arabia.

Expanded Newborn Screening Program in Saudi Arabia: Incidence of screened disorders

AIM

To address the implementation of the National Newborn Screening Program (NBS) in Saudi Arabia and stratify the incidence of the screened disorders.

METHODS

A retrospective study conducted between 1 August 2005 and 31 December 2012, total of 775 000 newborns were screened from 139 hospitals distributed among all regions of Saudi Arabia. The NBS Program screens for 16 disorders from a selective list of inborn errors of metabolism (IEM) and endocrine disorders. Heel prick dry blood spot samples were obtained from all newborns for biochemical and immunoassay testing. Recall screening testing was performed for Initial positive results and confirmed by specific biochemical assays.

RESULTS

A total of 743 cases were identified giving an overall incidence of 1:1043. Frequently detected disorders nationwide were congenital hypothyroidism and congenital adrenal hyperplasia with an incidence of 1:7175 and 1:7908 correspondingly. The highest incidence among the IEM was propionic acidaemia with an incidence rate of 1:14 000.

CONCLUSION

The article highlights the experience of the NBS Program in Saudi Arabia and providing data on specific regional incidences of all the screened disorders included in the programme; and showed that the incidence of these disorders is one of the highest reported so far world-wide.

Combined target site (kdr) mutations play a primary role in highly pyrethroid resistant phenotypes of Aedes aegypti from Saudi Arabia

Background

Pyrethroid resistance is a threat to effective vector control of Aedes aegypti, the vector of dengue, Zika and other arboviruses, but there are many major knowledge gaps on the mechanisms of resistance. In Jeddah and Makkah, the principal dengue-endemic areas of Saudi Arabia, pyrethroids are used widely for Ae. aegypti control but information about resistance remains sparse, and the underlying genetic basis is unknown. Findings from an ongoing study in this internationally significant area are reported here.

Methods

Aedes aegypti collected from each city were raised to adults and assayed for resistance to permethrin, deltamethrin (with and without the synergist piperonyl butoxide, PBO), fenitrothion, and bendiocarb. Two fragments of the voltage-gated sodium channel (Vgsc), encompassing four previously identified mutation sites, were sequenced and subsequently genotyped to determine associations with resistance. Expression of five candidate genes (CYP9J10, CYP9J28, CYP9J32, CYP9M6, ABCB4) previously associated with pyrethroid resistance was compared between assay survivors and controls.

Results

Jeddah and Makkah populations exhibited resistance to multiple insecticides and a similarly high prevalence of resistance to deltamethrin compared to a resistant Cayman strain, with a significant influence of age and exposure duration on survival. PBO pre-exposure increased pyrethroid mortality significantly in the Jeddah, but not the Makkah strain. Three potentially interacting Vgsc mutations were detected: V1016G and S989P were in perfect linkage disequilibrium in each strain and strongly predicted survival, especially in the Makkah strain, but were in negative linkage disequilibrium with 1534C, though some females with the Vgsc triple mutation were detected. The candidate gene CYP9J28 was significantly over-expressed in Jeddah compared to two susceptible reference strains, but none of the candidate genes was consistently up-regulated to a significant level in the Makkah strain.

Conclusions

Despite their proximity, Makkah and Jeddah exhibit significant differences in pyrethroid resistance phenotypes, with some evidence to suggest a different balance of mechanisms, for example with more impact associated with CYP450s in the Jeddah strain, and the dual kdr mutations 989P and 1016G in the more resistant Makkah strain. The results overall demonstrate a major role for paired target site mutations in pyrethroid resistance and highlight their utility for diagnostic monitoring.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-017-2096-6) contains supplementary material, which is available to authorized users.

Radiographic Diagnosis of Periapical Status and Quality of Root Canal Fillings in a Saudi Arabian Subpopulation

PURPOSE

To assess the prevalence of apical periodontitis (AP), as determined by orthopantomograms (OPGs), and its correlation with the quality of root fillings and coronal restorations.

MATERIALS AND METHODS

This cross-sectional study evaluated a random sample of 193 patients--112 (58%) females and 81 (42%) males--who presented as new patients at the Division of Endodontics. Digital OPGs were independently examined by two reliability-calibrated endodontists. The total number of teeth present, the location of the root canalfilled teeth, and the presence or absence of AP were recorded for each radiograph. The results were statistically analysed using the chi-square test followed by model building using multiple logistic regression.

RESULTS

A total of 324 endodontically treated teeth from the 193 selected radiographs were analysed. The mean number of teeth per patient was 25.5 ± 4.6, with an average of 1.64 root canal treatments per subject. Radiographically detected AP was associated with 190 (58.6%) root canal-treated teeth. The logistic model shows that the quality of endodontic treatment (adjusted odds ratio [ORa] = 1.82; 95% confidence interval [CI]: 1.40-3.17), status of coronal restoration (ORa = 1.77; 95% CI: 1.20-2.61) and the type of material used for coronal restorations (ORa = 1.39; 95% CI: 1.03-1.87) were significantly related to the periapical health of the teeth.

CONCLUSIONS

The quality of endodontic treatment, status of coronal restoration and the type of coronal restorative material were found to be the most important factors influencing the health of periradicular tissue.

Barriers and challenges in adopting Saudi telemedicine network: The perceptions of decision makers of healthcare facilities in Saudi Arabia

Despite emerging evidence about the benefits of telemedicine, there are still many barriers and challenges to its adoption. Its adoption is often cited as a failed project because 75% of them are abandoned or 'failed outright' and this percentage increases to 90% in developing countries. The literature has clarified that there is neither one-size-fit-all framework nor best-practice solution for all ICT innovations or for all countries. Barriers and challenges in adopting and implementing one ICT innovation in a given country/organisation may not be similar - not for the same ICT innovation in another country/organisation nor for another ICT innovation in the same country/organisation. To the best of our knowledge, no comprehensive scientific study has investigated these challenges and barriers in all Healthcare Facilities (HCFs) across the Kingdom of Saudi Arabia (KSA). This research, which is undertaken based on the Saudi Telemedicine Network roadmap and in collaboration with the Saudi Ministry of Health (MOH), is aimed at identifying the principle predictive challenges and barriers in the context of the KSA, and understanding the perspective of the decision makers of each HCF type, sector, and location. Three theories are used to underpin this research: the Unified Theory of Acceptance and Use of Technology (UTAUT), the Technology-Organisation-Environment (TOE) theoretical framework, and the Evaluating Telemedicine Systems Success Model (ETSSM). This study applies a three-sequential-phase approach by using three mixed methods (i.e., literature review, interviews, and questionnaires) in order to utilise the source triangulation and the data comparison analysis technique. The findings of this study show that the top three influential barriers to adopt and implement telemedicine by the HCF decision makers are: (i) the availability of adequate sustainable financial support to implement, operate, and maintain the telemedicine system, (ii) ensuring conformity of telemedicine services with core mission, vision, needs and constraints of the HCF, and (iii) the reimbursement for telemedicine services.

The clinical utility of normal range carbohydrate antigen 19-9 level as a surrogate marker in evaluating response to treatment in pancreatic cancer-a report of two cases

Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker that is has been has been intensely studied and investigated as a surrogate marker in pancreatic cancer (PC). It is also commonly utilized in the clinical management of PC. We report two cases where normal range CA 19-9 level has been shown to be useful as a surrogate marker for following PC progression and response to treatment. Initially in our cases, both patients had a resectable tumor and their tumor markers were within normal range. In both cases the normal range CA 19-9 increase from the baseline was associated with corresponding progressive disease on imaging studies and CA 19-9 decline was in keeping with response to systemic and local therapy despite being within the normal range. To our knowledge, this is the first case report where we report the utility of serial normal values of CA 19-9 as a useful tool in following PC disease activity and in response to treatment. Clinicians should consider measuring serial normal values of CA 19-9 in patients with PC and normal range CA 19-9 which may help in assessing response to treatment in subset of this population.

The value of routine bone marrow biopsy in patients with diffuse large B-cell lymphoma staged with PET/CT: a Danish-Canadian study

BACKGROUND

The added diagnostic and prognostic value of routine bone marrow biopsy (BMB) in patients with diffuse large B-cell lymphoma (DLBCL) undergoing positron emission tomography combined with computed tomography (PET/CT) staging is controversial.

PATIENTS AND METHODS

Patients with newly diagnosed DLBCL who underwent both staging PET/CT and BMB were retrospectively identified in British Columbia, Aalborg, and Copenhagen. Original written PET/CT and pathology reports were retrospectively reviewed to determine Ann Arbor stage and outcomes, with and without the contribution of BMB.

RESULTS

A total of 530 patients were identified: 146 (28%) had focal bone marrow (BM) lesions on PET/CT and 87 (16%) had positive BMB. Fifty-two of 146 patients (36%) with positive PET/CT had a positive BMB [39 DLBCL, 13 indolent non-Hodgkin lymphoma (iNHL)], while 35 of 384 patients (9%) with negative PET/CT had positive BMB (12 DLBCL, 23 iNHL). BMB upstaged 12/209 (6%) of stage I/II patients to stage IV, although this was the case for only 3 (1%) patients with DLBCL in the BMB. PET/CT identified BM involvement by BMB with sensitivity 60%, specificity 79%, positive predictive value 36%, and negative predictive value 91%. Concordant histological involvement of the BM by DLBCL was associated with worse overall survival and progression-free survival than discordant or no involvement in univariate and multivariate analyses.

CONCLUSIONS

In patients with DLBCL, staging PET/CT can miss BM involvement with concordant DLBCL (less common) or discordant iNHL (more common). Routine BMB does not add relevant diagnostic or prognostic value over PET/CT alone in the majority of patients with DLBCL.

IMMUNODEFICIENCIES. Impairment of immunity to Candida and Mycobacterium in humans with bi-allelic RORC mutations

Human inborn errors of immunity mediated by the cytokines interleukin-17A and interleukin-17F (IL-17A/F) underlie mucocutaneous candidiasis, whereas inborn errors of interferon-γ (IFN-γ) immunity underlie mycobacterial disease. We report the discovery of bi-allelic RORC loss-of-function mutations in seven individuals from three kindreds of different ethnic origins with both candidiasis and mycobacteriosis. The lack of functional RORγ and RORγT isoforms resulted in the absence of IL-17A/F-producing T cells in these individuals, probably accounting for their chronic candidiasis. Unexpectedly, leukocytes from RORγ- and RORγT-deficient individuals also displayed an impaired IFN-γ response to Mycobacterium. This principally reflected profoundly defective IFN-γ production by circulating γδ T cells and CD4(+)CCR6(+)CXCR3(+) αβ T cells. In humans, both mucocutaneous immunity to Candida and systemic immunity to Mycobacterium require RORγ, RORγT, or both.

Bacillus Calmette-Guérin vaccine related lymphadenitis in children: Management guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS)

The Bacillus Calmette–Guérin (BCG) vaccine contains live attenuated Mycobacterium bovis; was first used in humans to prevent tuberculosis (TB) in 1921. The World Health Organization (WHO) established the Expanded Program on Immunization in 1974 to ensure that all children have access to routinely recommended vaccines including BCG. Each year 120 million doses of BCG vaccine are administered worldwide. Intradermal BCG vaccine gives rise to a classic primary complex that consists of a cutaneous nodule at the site of injection and subclinical involvement of the regional lymph nodes, which is self-limiting and requires no treatment.

However, ipsilateral regional lymph node enlargement may follow BCG vaccine and is considered as the most common complication, some progress to suppuration. Rarely a disseminated BCG infection may develop in immunocompromised individuals resulting in a devastating outcome. Within the last decades, variable strategies have been applied in treating lymphadenitis related to BCG vaccine, ranging from observation, anti-mycobacterial therapy, aspiration, incision and drainage to lymph node surgical excision.

We are presenting these guidelines that intended to optimize and standardize management of various types of BCG related lymph adenitis in children. They are based upon the best available evidence in literature beside our experience in this field.