Drug-Drug Interactions and the Clinical Tolerability of Colchicine Among Patients With COVID-19: A Secondary Analysis of the COLCORONA Randomized Clinical Trial.

Importance: Colchicine has many drug-drug interactions with commonly prescribed medications. Only pharmacokinetic studies have provided data on colchicine drug-drug interactions. Objective: To evaluate the clinical tolerability of colchicine according to the presence or absence of a drug-drug interaction. Design, Setting, and Participants: A secondary analysis of the COLCORONA trial was performed. The COLCORONA trial was a randomized, double-blind, placebo-controlled trial conducted in Brazil, Canada, Greece, South Africa, Spain, and the US between March 23, 2020, and January 20, 2021. The COLCORONA trial included ambulatory patients with COVID-19 with at least 1 high-risk characteristic and compared the effects of colchicine (0.5 mg twice daily for 3 days, then 0.5 mg daily thereafter) with placebo for 27 days. Data analysis was performed from February 24, 2023, to June 20, 2024. Exposure: In this secondary analysis, baseline medications that had interactions with colchicine were identified using a previously published expert classification. Main Outcomes and Measures: The primary outcome for this analysis was the composite of serious and nonserious treatment-related and treatment-unrelated gastrointestinal adverse events. The secondary outcomes were other adverse events and the composite of death or hospital admission due to COVID-19 infection. Logistic regression models adjusted for age, sex, estimated glomerular filtration rate, diabetes, heart failure, and myocardial infarction were assessed for effect modification of the association between the randomization arm and the outcomes of interest by drug-drug interaction status. Results: The cohort included 2205 participants in the colchicine arm and 2227 in the placebo arm (median age, 54 [IQR, 47-61] years; 2389 [54%] women). The most common colchicine drug-drug interactions were rosuvastatin (12%) and atorvastatin (10%). In fully adjusted models, the odds of any gastrointestinal adverse event were 1.80 (95% CI, 1.51-2.15) times higher in the colchicine arm than the placebo arm among people without a drug-drug interaction and 1.68 (95% CI, 1.24-2.26) times higher in the colchicine arm than the placebo arm among people with a drug-drug interaction (P = .69 for interaction). Drug-drug interaction status did not significantly modify the effect of colchicine on the composite of COVID-19 hospitalization or death (odds ratio, 0.91; 95% CI, 0.59-1.40 for drug-drug interaction and 0.84; 95% CI, 0.60-1.19 for no drug-drug interaction; P = .80 for interaction). Conclusions and Relevance: In this secondary analysis of the COLCORONA trial, operational classification of drug interactions system class 3 or 4 drug-drug interactions did not appear to significantly increase the risk of colchicine-related adverse effects. Trial Registration: ClinicalTrials.gov Identifier: NCT04322682.

Assessing Saudi women's awareness about human papillomavirus (HPV) and their susceptibility to receive the vaccine.

Cervical cancer is a significant health concern for women worldwide, with human papillomavirus (HPV) being the primary cause. This study aimed to assess Saudi women's awareness and knowledge of HPV, determine their information sources, and evaluate their intention to receive the HPV vaccine. A questionnaire-based survey was conducted among 654 Saudi females aged 18 to 60 years from January to May 2023. The results revealed that 60.85% of the participants had heard about HPV, but only 8.25% had received the HPV vaccination. Despite the low vaccination rate, 71.11% of the respondents expressed willingness to receive the vaccine. Educational level was the significant predictor of the vaccine awareness and acceptance. The internet and social media were the most prevalent sources of information about HPV. The study highlights the need for additional education about HPV-related diseases and vaccination among Saudi women. Although there is a high level of HPV vaccine acceptance, the lack of knowledge suggests that targeted educational interventions are necessary to increase awareness and promote vaccination uptake. These findings can inform public health strategies to reduce the burden of cervical cancer in Saudi Arabia through improved HPV vaccination coverage and education.

Evaluation of the automated dispensing cabinets users' level of satisfaction and the influencing factors in Al-Ahsa hospitals.

Automated dispensing cabinets (ADCs) are decentralized, computer-controlled systems used to store, distribute, and track medications at the point of care in the wards. Objective: The objective of the current study is to evaluate how healthcare practitioners are satisfied with ADCs and scrutinize some influencing factors that could affect this satisfaction. Material: A cross-sectional survey study was designed and distributed online to healthcare providers in Al-hasa hospitals. Results: A total of 166 participants. Regarding the frequency and pattern of ADC use, around 79.5% used ADC and 85.4% were informed about using ADC on a daily basis. As for the level of satisfaction with ADC, an exact 81.9% gave a high rate for overall satisfaction, 81.3% were highly satisfied with the system's accuracy, and 74.7% were highly satisfied with the time it takes to complete the task. Regarding usability of the system, 69.8% thought it was easy whereas 36.8% agreed that the time required for reloading medication is longer than before ADC. Furthermore, 79.5% agreed that ADC allowed them to accomplish their job safely, and 67.4% agreed that it improved their productivity. Regarding challenges, 74.7% agreed that all drawer types assure safe access and removal of medications, and 18.7% agreed that there is a significant potential for loss of data. Conclusion: This study investigated healthcare staff's perceptions and satisfaction with ADCs in Al-hasa hospitals. The healthcare participants were mostly highly satisfied with the use of the ADCs which translated into better patient care and improved patient safety as well as higher productivity.

Awareness of Thyroid Diseases and Their Risk Factors Among the Residents of Jeddah, Saudi Arabia.

Background The thyroid gland is responsible for regulating many aspects of body functions. Despite their global prevalence, thyroid disorders often go underdiagnosed, which can lead to serious health complications. In Saudi Arabia, the overall prevalence was 49.76%, among which subclinical hypothyroidism was the most prevalent type. Raising awareness and knowledge about thyroid diseases and their risk factors is essential for the prevention and early treatment of these disorders. Aim and objectives To assess the awareness of thyroid diseases and their risk factors among the residents of Jeddah, Saudi Arabia, as well as understand their attitudes and underlying influencing factors toward thyroid health. Methods A cross-sectional study was conducted in Jeddah, Saudi Arabia, from January 2023 to December 2023. The study included a diverse sample of Saudi and non-Saudi participants aged 18 to 65 years. A self-administered online questionnaire translated into Arabic was used to collect information. Results The study involved 393 participants, 72.5% female and 27.5% male. Most participants held a bachelor's degree or higher (78.1%). Hypothyroidism was the most prevalent diagnosed thyroid disease (14.0%). Only 20% of participants had good knowledge. Respondents were relatively less aware of the risks associated with pregnancy and the postpartum period (35%), medications such as amiodarone (26%), eating soya beans (22%), and gastrointestinal tract (GIT) symptoms of thyroid diseases (36%). Attitudes toward thyroid health were generally negative (85.5%). However, a significant association was noted between a history of thyroid disease and a positive attitude (p = 0.002). Educational level and employment status were strong determinants of knowledge levels (p = 0.036 and 0.005, respectively). A positive correlation was found between knowledge levels and attitudes (r = 0.321, p < 0.001). Conclusion The study showed a low level of awareness among participants living in Jeddah, especially the unemployed and those with low levels of education. Their unawareness of the possible risks of thyroid diseases during pregnancy should be thoroughly addressed by public campaigns.

Prevalence of Adverse Respiratory Symptoms Among E-Cigarette Users in Saudi Arabia - A Cross-Sectional Study.

Electronic cigarettes, frequently referred to as e-cigarettes, have emerged as a controversial and rapidly growing phenomenon in the realm of tobacco and nicotine consumption worldwide. This study reports the prevalence of respiratory symptoms among e-cigarette users. This study also helps to understand the potential harmful effects and importance of quitting e-cigarette smoking. An observational cross-sectional study was carried out in Saudi Arabia. The study period was from September 2022 to August 2023. The sample size was 447 participants. Among recent e-cigarette users in this Saudi study, usage varied, with 44.1% using 1-5 days, 33.6% using 6-30 days, and 22.4% using e-cigarettes previously but not in the previous month. Vape devices were predominant (42.7%). There were significant associations emerged between e-cigarette use frequency and symptoms such as fatigue, breathlessness, and shortness of breath. E-cigarette use was notably linked to asthma-related symptoms, underscoring its concerning impact on respiratory health (P < 0.05). E-cigarette consumption has a significant impact on respiratory effects and specifically asthma-related symptoms among this Saudi population.

Understanding the effects of COVID-19 on patients with diabetic nephropathy: a systematic review.

Background: Diabetic nephropathy is one of the consequences of diabetes mellitus that causes a continuous decline in the eGFR. After the COVID-19 pandemic, studies have shown that patients with diabetic nephropathy who had contracted COVID-19 have higher rates of morbidity and disease progression. The aim of this study was to systematically review the literature to determine and understand the effects and complications of SARS-CoV-2 on patients with diabetic nephropathy. Materials and methods: The authors' research protocol encompassed the study selection process, search strategy, inclusion/exclusion criteria, and a data extraction plan. A systematic review was conducted by a team of five reviewers, with an additional reviewer assigned to address any discrepancies. To ensure comprehensive coverage, the authors employed multiple search engines including PubMed, ResearchGate, ScienceDirect, SDL, Ovid, and Google Scholar. Results: A total of 14 articles meeting the inclusion criteria revealed that COVID-19 directly affects the kidneys by utilizing ACE2 receptors for cell entry, which is significant because ACE2 receptors are widely expressed in the kidney. Conclusion: COVID-19 affects kidney health, especially in individuals with diabetic nephropathy. The mechanisms include direct viral infection and immune-mediated injury. Early recognition and management are vital for improving the outcomes.

Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan.

OBJECTIVE: This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan. METHODOLOGY: This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023). RESULTS: Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place. CONCLUSIONS: This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.

Effects of Cycloastragenol on Alzheimer's Disease in Rats by Reducing Oxidative Stress, Inflammation, and Apoptosis.

BACKGROUND: As individuals age, they may develop Alzheimer's disease (AD), which is characterized by difficulties in speech, memory loss, and other issues related to neural function. Cycloastragenol is an active ingredient of Astragalus trojanus and has been used to treat inflammation, aging, heart disease, and cancer. OBJECTIVES: This study aimed to explore the potential therapeutic benefits of cycloastragenol in rats with experimentally induced AD. Moreover, the underlying molecular mechanisms were also evaluated by measuring Nrf2 and HO-1, which are involved in oxidative stress, NFκB and TNF-α, which are involved in inflammation, and BCL2, BAX, and caspase-3, which are involved in apoptosis. METHODS: Sprague-Dawley rats were given 70 mg/kg of aluminum chloride intraperitoneally daily for six weeks to induce AD. Following AD induction, the rats were given 25 mg/kg of cycloastragenol daily by oral gavage for three weeks. Hippocampal sections were stained with hematoxylin/ eosin and with anti-caspase-3 antibodies. The Nrf2, HO-1, NFκB, TNF-α, BCL2, BAX, and caspase-3 gene expressions and protein levels in the samples were analyzed. RESULTS: Cycloastragenol significantly improved rats' behavioral test performance. It also strengthened the organization of the hippocampus. Cycloastragenol significantly improved behavioral performance and improved hippocampal structure in rats. It caused a marked decrease in the expression of NFκB, TNF-α, BAX, and caspase-3, which was associated with an increase in the expression of BCL2, Nrf2, and HO-1. CONCLUSION: Cycloastragenol improved the structure of the hippocampus in rats with AD. It enhanced the outcomes of behavioral tests, decreased the concentration of AChE in the brain, and exerted antioxidant and anti-inflammatory effects. Antiapoptotic effects were also noted, leading to significant improvements in cognitive function, memory, and behavior in treated rats.

Unlocking the Power of Influenza Vaccines for Pediatric Population: A Narrative Review.

The flu, often known as influenza, is a dangerous public health hazard for the pediatric population. Immunization is essential for decreasing the burden of the disease and avoiding complications related to influenza. However, the immunogenicity, efficacy, and safety of different influenza vaccines in children warrant careful evaluation. The purpose of this narrative review is to give a summary of the existing literature on the immunogenicity, efficacy, and safety of several vaccinations against influenza viruses in children. The review incorporates evidence from a range of studies focusing on the outcomes of interest. Immunogenicity studies have shown that influenza vaccines induce a robust immune response in children, primarily through neutralizing antibodies' formation. However, variations in vaccine composition influence the duration and magnitude of immune responses. Safety is a crucial consideration in pediatric vaccination. In children, influenza vaccinations have generally shown a high safety profile, with mild and temporary side effects being the most common. Vaccinations against influenza have shown a modest level of efficacy in avoiding hospitalizations linked to influenza, laboratory-confirmed influenza infections, and serious consequences in children. Live attenuated vaccines have shown higher effectiveness against matched strains compared to inactivated vaccines. In conclusion, this narrative review highlights that receiving influenza vaccination in children aged six to 47 months is very important. While different vaccines exhibit varying immunogenicity, safety profiles, and effectiveness, they all contribute to reducing the burden of influenza among children. Future research should focus on optimizing vaccine strategies, improving vaccine coverage, and evaluating long-term protection.

Evaluation of Cellular Changes and Immunohistochemistry Expression of p53 and p16 in the Oral Mucosa Among Saudi Smokers.

BACKGROUND: Smoking is a well-known risk factor for various health problems, including oral cancer. P16 and P53 proteins are involved in cell cycle regulation and proliferation, and their expression levels can provide insights into cellular health. OBJECTIVE: This study aims to evaluate the cellular changes and immunohistochemistry expression of p53 and p16 in the oral mucosa among Saudi smokers. METHOD: In a cross-sectional study obtained by scraping the buccal mucosa, 1000 samples were collected from 2022 to 2023. All of the study's participants were Saudi citizens of both genders. Seven hundred cigarette smokers and 300 nonsmokers made up the controls, using two sampling techniques: initially purposive and then snowball sampling. The materials were subjected to immunohistochemical analysis for P16 and P53 protein overexpression. The samples were scored based on the percentage of positively stained cells and staining intensity. The data were analyzed using SPSS, and categorical variables were identified as frequencies and percentages using the chi-squared test; a value of (P<0.05) was considered significant. RESULT: Cigarette smokers demonstrate significantly higher rates of cytological inflammation, reverse cytological infection, atypia, and binucleated/multinucleated cells compared to nonsmokers, with an overall abnormal result rate of 46% versus 18.7%, respectively (P=0.024). The study found higher P53 and P16 expression among smokers (7.14% and 2.14%, respectively) compared to nonsmokers (0.1% and 0.33%) (P=0.038). No significant differences were observed in P53/P16 expression across age groups (P=0.72) or between male and female participants (P=0.25). CONCLUSION: These findings highlight the detrimental effects of smoking on cellular health and reinforce the importance of smoking cessation in reducing the risk of developing cytological abnormalities and associated diseases. These results highlight the association of smoking with increased biomarker expression, emphasizing its relevance in understanding oral health risks.

Echinacoside ameliorates hepatic fibrosis and tumor invasion in rats with thioacetamide-induced hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) affects approximately 800,000 individuals globally each year. Despite advancements in HCC treatments, there is still a pressing need to identify new drugs that can combat resistance. One potential option is echinacoside, a natural caffeic acid glycoside with antioxidant, anti-inflammatory, antidepressant, and antidiabetic properties. Therefore, we aimed to investigate the ability of echinacoside to exhibit antitumor activity against HCC in rats through ameliorating hepatic fibrosis and tumor invasion. Rats were given thioacetamide to induce HCC, and some were given 30 mg/kg of echinacoside twice a week for 16 weeks. The liver impairment was assessed by measuring serum α-fetoprotein (AFP) and examining liver sections stained with Masson trichrome or anti-transforming growth factor (TGF)-ß1 antibodies. The hepatic expression of mRNA and protein levels of TGF-ß1, ß-catenin, SMAD4, matrix metalloproteinase-9 (MMP9), phosphoinositide 3-kinases (PI3K), mammalian target of rapamycin (mTOR), connective tissue growth factor 2 (CCN2), E-Cadherin, platelets derived growth factor (PDGF)-B and fascin were also analyzed. Echinacoside improved the survival rate of rats by decreasing serum AFP and the number of hepatic nodules. Examination of micro-images indicated that echinacoside can reduce fibrosis. It also significantly decreased the expression of TGF-ß1, ß-catenin, SMAD4, MMP9, PI3K, mTOR, CCN2, PDGF-B, and fascin while enhancing the expression of E-Cadherin. In conclusion, echinacoside exhibits a protective effect against HCC by increasing survival rates and decreasing tumor growth. It also acts as an inhibitor of the hepatic tissue fibrosis pathway by reducing the expression of TGF-ß1, ß-catenin, SMAD4, PI3K, CCN2, PDGF-B and mTOR. Additionally, it prevents tumor invasion by suppressing MMP9 and fascin, and increasing the expression of E-Cadherin.

Medical Students' Perception of Pathology in Saudi Arabia.

Pathology is the bridge between basic science and clinical practice. An inadequate perception of pathology leads to an incomplete understanding of diseases, which consequently affects its management. This study aims to identify medical students' perceptions of pathology in medical colleges around Saudi Arabia and use their feedback to improve teaching strategies. A validated online self-structured questionnaire form was distributed to medical students in basic and clinical years, including private and governmental universities in all regions of Saudi Arabia. The study comprised a total of 476 medical students. It revealed that n = 226 (48%) of the participants were not aware of pathologists' roles, and n = 262 (55%) of students reported that the main reason was insufficient exposure to actual pathology practice. A total of n = 209 (44%) students believed the current teaching methods in the basic years were insufficient to provide clear perceptions of pathology. The majority of participants n = 366 (77%) chose practical sessions as the most effective strategy in teaching pathology. Our study demonstrated that medical students require more engagement in laboratories to improve their perception. We suggest that Saudi medical schools need to deliver more comprehensive and practical teaching methods that reflect the actual practice of pathology.

Awareness and Risk Assessment of Breast Cancer Among Women in Saudi Arabia: A Cross-Sectional Study.

Background Breast cancer is the most common female cancer worldwide including in Saudi Arabia. As a result, many cases are diagnosed at an advanced stage, leading to a poor outcome. Understanding risk perception is a significant component of awareness of breast cancer risks. It can be helpful to reduce the mortality of breast cancer via increasing awareness of the risk factors. Objective Our study was designed to assess the level of awareness among women in Saudi Arabia regarding breast cancer, including knowledge about risk factors, symptoms, and the importance of early detection. Methods A cross-sectional study was conducted, and participants were randomly selected. The target population in this study is all women in Saudi Arabia. Data was collected via an online questionnaire. The collected data was analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 21.0, Armonk, NY). Results About 713 women were enrolled in this study. Most of them (69%) were within the age group of 35-45 years old. Age at menarche was found to be 12-13 years old in 313 (43.9%) of the participants and age at first live birth was found to be 20-24 in about 360 (50.5%). The number of population with first-degree relatives that have a history of breast cancer is one relative in 126 (17.7%) of the participants and about 36 (5%) had breast biopsy. About 76 (10.7%) of the participants were considered as having a high risk of breast cancer according to the estimated five-year breast cancer-risk assessment (had a five-year breast cancer risk >1.66%). The mean knowledge score of the participants about breast cancer was found to be 4.62 ± 1.86 out of 8. About 509 (71.4%) of the participants were considered to be having a good level of knowledge about breast cancer. Long-term hormone contraceptive use and older age can increase the chance of developing breast cancer as agreed on by 363 (50.9%) and 287 (40.3%) of the participants respectively. A total of 677 (95%) of the participants mentioned that early detection is important to survive breast cancer. And 639 (89.6%) of the participants think that breast cancer is treatable and about 288 (40.4%) think that the suitable age to start mammography is above 30 years old. Conclusion There is a good general knowledge and awareness about breast cancer among study participants. There were few knowledge gaps regarding the effect of obesity, hormonal contraceptives and older age on the association with breast cancer. About 10% of the participants were found to be having high five-year breast cancer risk.

The Accuracy of Breast Cancer Diagnostic Tools.

Background Breast cancer (BC) remains a significant health concern, leading to illness and death among women globally. It is essential to detect BC early using imaging techniques that accurately reflect the final pathology, guiding suitable intervention strategies. Objectives This study aimed to evaluate the agreement between radiological findings and histopathological results in BC cases. Methods We conducted a retrospective review of breast core needle biopsies (CNBs) in women over a six-year period (2017-2022) at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. The pathological diagnoses were compared with the findings from preceding radiological investigations. We also compared the tumour sizes in the resection specimens with their radiological counterparts. Results A total of 641 cases were included in the study. Ultrasound (US), mammography, and magnetic resonance imaging (MRI) yielded diagnostic accuracies of 85%, 77.9%, and 86.9%, respectively. MRI had the highest sensitivity at 72.2%, while US had the lowest at 61%. MRI provided the best agreement with the final resected tumor size. By contrast, mammography tended to overestimate the size (41.9%), and US most frequently underestimated it (67.7%). The connection between basal-like molecular subtypes and the Breast Imaging Reporting and Data System (BIRADS)-5 classifications was only statistically significant for MRI (p = 0.04). The luminal subtype was more likely to show speculation in mammography. Meanwhile, BIRADS-4 revealed a considerable number of benign pathologies across all the three modalities. Conclusions MRI demonstrated the highest accuracy, sensitivity, specificity, and positive predictive value (PPV) for diagnosing and estimating the tumor size. Mammography outperformed US in terms of sensitivity and yielded the highest negative predictive value (NPV). US, meanwhile, offered superior specificity, PPV, and accuracy. Therefore, combining these diagnostic methods could yield significant benefits.

Prevalence and Risk Factors of Clostridium difficile Infection Among Patients Hospitalized for a Flare of Inflammatory Bowel Disease in King Abdulaziz University Hospital.

Background The gram-negative anaerobe Clostridium difficile is the main infectious cause of pseudomembranous colitis and infectious diarrhea in hospitalized patients. Inflammatory bowel disease (IBD) patients have been proven to have higher rates of Clostridium difficile infection (CDI). Antibiotic use is the most well-known of the several risk factors for CDI. A few more are advanced age, previous hospitalization, increased severity of an underlying illness, gastrointestinal surgery, and proton pump inhibitors. This study aimed to find out which factors predict CDI in IBD patients at King Abdulaziz University Hospital in Jeddah. Methods We conducted a retrospective cohort study of all inflammatory bowel disease patients who developed CDI with a total sample of 602 patients from 2009 through 2022 at King Abdulaziz University in Jeddah, Saudi Arabia. We identified the clinical data of patients diagnosed with CDI and admitted to the hospital for either diagnosis or follow-up, and we measured the frequencies and percentages as qualitative data and the mean ( standard deviation) as quantitative variables. A chi-square test was used to estimate the correlation between Clostridium difficile infections and multiple factors, including a history of previous hospitalizations, recent flares, intestinal manifestations, extraintestinal manifestations, comorbidities, and IBD medications. Meanwhile, independent t-tests were performed to analyze the continuous variables. Results Out of 602 IBD patients, 53 patients (8.8%) had a confirmed CDI test using an immunoassay for Clostridium difficile toxins A and B. Most of the patients were female and nonsmokers. Regarding colonic involvement, 47 individuals with the disease extending to their large colon also evaluated positive for CDI. Among patients with a positive history of CDI, there were 21 patients with a recent flare-up of fewer than five episodes, five patients had more than five episodes, and the rest did not have any recent flare-ups. Also, IBD patients were significantly at a higher risk for intestinal resection. Conclusion IBD patients are more susceptible to CDI due to flare-ups that require hospitalization and their medications. As a result, clinicians must consider CDI testing in IBD patients who are hospitalized and who are receiving medication to ensure early diagnosis and therapy.

The Effect of Weaning Practices on the Nutritional and Health Status of Saudi Preschool Children.

Background Weaning is a complex procedure that gradually introduces complementary foods to the baby's diet. Solid food should be started between the ages of 6 and 12 months. Weaning is a challenging and crucial stage in an infant's development. Extreme caution should be used during weaning an infant because delaying it can cause issues like sluggish growth, difficulties feeding, malnutrition, and iron deficiency. Objective The current study aims to determine the impact of delayed or early weaning practices on the nutritional status of preschool children in Saudi Arabia. Data was gathered about the time of complementary food introduction, preferred foods in the initial stages, and a child's health compared to those practices.  Methodology By convenient sampling, a cross-sectional study was conducted to gather data from 385 parents of Saudi children at preschool age. Questionnaires were shared online. Data were recorded and analyzed on IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Descriptive analysis and multivariate ANOVA (MANOVA) tests were performed. Results Only 6.23% of the infants were introduced to complimentary food at optimal age (6 to 12 months), whereas 85% were found to have delayed weaning. As per the BMI, 74.4% of preschool children were severely underweight, 53.6% of infants consumed pureed vegetables early during weaning, and 64% of infants were introduced to eggs and cheese within the first year of life. The timing, pattern, and food items of weaning had a significant (p<0.05) impact on general physical health, as 48.8% of children had pale skin, 46.9% felt tired, 36.5% had swollen joints, and 42% complained of itching and an upset stomach. Conclusion This study couldn't define the direction of significance. Further studies can be done on a larger scale where biochemical tests, and screening can be done on children to find if any significant health problem is prevailing, and the direction of association can be defined.

Public Knowledge, Attitude, and Practice Toward Herpes Zoster Vaccination in Saudi Arabia.

Introduction Herpes zoster (HZ) is a viral infection that occurs due to the reactivation of the varicella-zoster virus (VZV). Reactivation of the latent virus causes a painful dermatomal rash that is typical in HZ, which is frequently accompanied by post-herpetic neuralgia (PHN). Although HZ negatively impacts individuals' quality of life, vaccination has been shown to reduce the incidence of HZ and PHN and reduce the severity of the disease in the event of a breakthrough. Nonetheless, several studies have shown a low level of knowledge and poor practices regarding HZ and its vaccine. However, only two studies on this issue have been conducted in the Middle East. This study aimed to assess the level of knowledge, attitudes, and practices toward HZ vaccinations among the Saudi population aged 50 years and older. Methods A cross-sectional observational study was conducted from December 2022 to July 2023 involving citizens aged 50 years and older in Saudi Arabia. Data were collected using an online, validated, close-ended structured questionnaire distributed through social media. Linear regression analysis was used to assess independent predictors of knowledge regarding HZ, knowledge regarding the HZ vaccine, and attitudes toward HZ. Categorical variables were dummy-coded. Binary logistic regression was used to assess factors associated with the willingness to receive the HZ vaccine. Results A total of 368 respondents completed the questionnaire. The mean knowledge scores (%) regarding HZ and its vaccine were 28.6% and 37.1%, respectively. While 51.6% (n = 190) claimed to be aware of the HZ vaccine, only 31.6% (n = 60) had a knowledge score of 80% or higher. Multivariate analysis showed that knowledge was positively associated with female gender, prior chickenpox infection, and higher education. Only 54.4% of the respondents were willing to get the HZ vaccine, and 28.8% were willing to pay out of pocket for the HZ vaccine. Conclusion The results suggest that educational campaigns on HZ and its vaccine targeting at-risk groups are required to raise awareness and increase the public's knowledge. Additionally, healthcare personnel's recommendation of the HZ vaccine to the target population should be encouraged, as it is an important factor in vaccine acceptability.

The Impact of COVID-19 on Preterm Birth Among Pregnant Women in Al-Qassim, Saudi Arabia.

BACKGROUND: Pregnant women are regarded as a unique group due to the distinct immunological condition that pregnancy produces, which makes pregnant women more susceptible to respiratory infections like coronavirus disease 2019 (COVID-19) and its consequences. During pregnancy, many viral infections have been recognized to increase the risk of adverse obstetrical outcomes such as preterm delivery. The purpose of this study was to investigate the effects of COVID-19 infection on preterm birth in pregnant women in the Al-Qassim region of Saudi Arabia. METHODS:  This retrospective cohort study was conducted in Saudi Arabia between December 2019 to October 2021. The target subjects were pregnant women with live singleton gestations who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing for COVID-19 infection during their delivery hospitalization. Data gathered included patient demographic information, clinical characteristics, and pregnancy outcomes. Data were analyzed using R version 4.1.1 (R Core Team (2021); R Foundation for Statistical Computing, Vienna, Austria). RESULTS:  A total of 381 pregnant women were included. The median maternal age of women was 31.0 years (IQR: 27.0, 35.0) and the median BMI value was 30.5 kg/m2 (IQR: 26.9, 34.8). The most common comorbidities were diabetes (7.1%) and asthma (4.5%). A known history of preterm birth was prevalent among 2.9%. Of the participants, 13.6% had a prenatal COVID-19 infection, of whom 57.7% had their infections resolved. The prevalence of positive PCR testing was 13.6%. Preterm birth occurred in 46 women (12.1%, 95%CI 9.1-15.9). Preterm birth was significantly associated with having a maternal age of ≥35 years, having high frequencies of parity, and having a past history of preterm birth, as well as having a history of hypertension and diabetes. Preterm birth was not significantly associated with having a confirmed COVID-19 infection at delivery. CONCLUSION: It was shown that preterm birth is evident among women with COVID-19 infection. Preterm birth is significantly associated with old age, multiparity, and a history of preterm delivery. Preterm birth is not significantly associated with having a confirmed COVID-19 infection at delivery. More research regarding infection-related adverse effects is advised and should be highlighted.

Awareness of Stem Cell Therapy for Diabetes Among Type II Diabetic Patients in Makkah: A Cross-Sectional Study.

Background Diabetes mellitus is a chronic disease that affects millions of people worldwide. Several studies have suggested using stem cells for diabetes treatment. However, there is a lack of research assessing the population's awareness of stem cells. This study aimed to evaluate the level of awareness regarding the use of stem cell therapy for type 2 diabetes mellitus (T2DM). Methodology This study was conducted from December 2021 to April 2022 through an online survey that was distributed electronically via social media platforms. T2DM patients or their care providers who lived in Makkah were included. Patients aged less than 18 years and those with mental disabilities were excluded. Results Of the 316 participants included in the study, 56% were males, 33% had an age range of 46-55 years, and 76% were married. T2DM patients and their caregivers had a moderate level of awareness about stem cell therapy, with caregivers having higher awareness than diabetic patients. A non-significant relationship was found between educational level, income, diabetes control, time of diagnosis, and patients' awareness. However, regarding the decision of treatment, participants aged less than 35 years were highly likely to decide to undergo stem cell treatment compared to other age groups. Conclusions There is a moderate level of awareness about stem cell therapy as a treatment option for T2DM among T2DM patients and caregivers in Makkah. Hence, there is a need to raise awareness by using online and in-person well-organized education programs in Makkah.

Obstacles and Satisfaction to Balance Between Family Life and Medical Career Among Saudi Women Doctors.

BACKGROUND:  Besides their medical career obligations, female physicians traditionally have assumed responsibility for raising families and maintaining the household. Finding an acceptable balance between their career and family life is challenging. OBJECTIVE:  The study aimed to discover the obstacles and the relationship between the barriers/factors with the satisfaction in balancing career and family life. METHODOLOGY:  A cross-sectional study that analyzed data from Saudi female physicians. The study included 165 female physicians from the six Ministry of Health hospitals in Al-Madinah Al-Munawarah; 65 were specialists and consultants, and 100 were general practitioners and residents. The data were collected from October until the end of November 2022 through a semi-structured, self-administered questionnaire gathered by convenience sampling. The data were collected and analyzed with SAS software. RESULTS:  The study's main findings include a satisfaction rate in balancing career and family life among the studied female physicians, which was low at 15.7%. In comparison, female physicians unsatisfied with such balancing were 38.2%. The effect of family responsibilities on career choice was nearly equal, where 50.3% of the studied female physicians affected them. There was a statistically significant difference regarding the satisfaction in balancing career with family life by their specialty; female surgeons and gyn/obs physicians found a higher percentage of unsatisfaction, whereas, among family medicine physicians, the least rate of unsatisfaction was found (P-value < 0.01). At 80% of the studied physicians suggested providing childcare centers as the main solution to their difficulties and obstacles; also, 46.5% suggested taking more days off of maternity leave. Transportation difficulties, however, represented the lowest type of difficulty, 12.7%. CONCLUSION:  The present study has revealed several obstacles facing female physicians that negatively impact relationships with their families.