Exploring the potential use of melatonin as a modulator of tramadol-induced rewarding effects in rats.

Background: Melatonin is responsible for regulating the sleep-wake cycle and circadian rhythms in mammals. Tramadol, a synthetic opioid analgesic, is used to manage moderate to severe pain but has a high potential for abuse and dependence. Studies have shown that melatonin could be a potential modulator to reduce tramadol addiction. Methods: Male Wistar rats were used to investigate the effect of melatonin on tramadol-induced place preference. The rats were divided into four groups: control, tramadol, tramadol + melatonin (single dose), and tramadol + melatonin (repeated doses). Tramadol was administered intraperitoneally at 40 mg/kg, while melatonin was administered at 50 mg/kg for both the single dose and repeated-dose groups. The study consisted of two phases: habituation and acquisition. Results: Tramadol administration produced conditioned place preference (CPP) in rats, indicating rewarding effects. However, melatonin administration blocked tramadol-induced CPP. Surprisingly, repeated doses of melatonin were ineffective and did not reduce the expression of CPP compared to that of the single dose administration. Conclusion: The study suggests that melatonin may be a potential therapeutic option for treating tramadol addiction. The results indicate that melatonin attenuates the expression of tramadol-induced CPP, supporting its uses as an adjunct therapy for managing tramadol addiction. However, further studies are needed to investigate its effectiveness in humans.

The utility of serum glucose potassium ratio as a predictive factor for haemorrhagic transformation, stroke recurrence, and mortality among ischemic stroke patients.

Background and Objective: Glucose-Potassium Ratio (GPR) has emerged as a biomarker in several pathophysiological conditions. However, the association between GPR and long-term outcomes in stroke patients has not been investigated. Our study evaluated the applicability of baseline GPR as a predictive prognostic tool for clinical outcomes in ischemic stroke patients. Methods: The multicenter retrospective cohort study included acute-subacute adult ischemic stroke patients who had their baseline serum GPR levels measured. Eligible patients were categorized into two sub-cohorts based on the baseline GPR levels (<1.67 vs. ≥ 1.67). The primary outcome was the incidence of 30-day hemorrhagic transformation, while stroke recurrence, and all-cause mortality within twelve months, were considered secondary. Results: Among 4083 patients screened, 1047 were included in the current study. In comparison with GPR < 1.67 group, patients with ≥ 1.67 GPR had a significantly higher ratio of all-cause mortality within twelve months (aHR 2.07 [95 % CI 1.21-3.75] p = 0.01), and higher ratio of 30-day hemorrhagic transformation but failed to reach the statistical significance (aHR 1.60 [95 % CI 0.95-2.79], p = 0.08). Conclusion: Overall, baseline GPR serum is an independent predictor of all-cause mortality within twelve months in patients with acute and subacute ischemic stroke. Further clinical studies are necessary to validate these findings.

Neurosurgery Residents' Satisfaction Toward Their Saudi Training Program: Insights from a National Survey.

BACKGROUND: Given the high-stakes nature of their work, neurosurgery residents face constant pressure and require high-quality training to succeed. We aim to investigate the satisfaction levels of residents with their Saudi Neurosurgery Residency Training Program (SNRTP) and its influential factors. METHODS: This is a nationwide, cross-sectional study that employed a questionnaire, structured based on the relevant literature, which was disseminated to neurosurgery residents, commencing from December 2021 and culminating in September 2022. RESULTS: A total of 70 out of 143 neurosurgery residents were included, giving a response rate of 48.9%. Most participants (62.9%) aged 24-28 years old, 55.7% were males, and 40.0% were from the Central region of Saudi Arabia. The residents were further divided into juniors (R1-R3; 64.3%) and seniors (R4-R6; 35.7%). Approximately 13.3% of the juniors were satisfied with the SNRTP, whereas only 8.0% of the seniors were satisfied. Dissatisfaction rates over the SNRTP were significantly higher in the seniors (68.0%) compared to the juniors (28.9%; P = 0.006). The frequency of operating room sessions per week and presence of protected research time were the only 2 factors significantly associated with the junior and senior residents' satisfaction, respectively. CONCLUSIONS: The SNRTP has a vision to provide the society with elite competent neurosurgeons. However, we found a degree of dissatisfaction among the residents, indicating a need for improving the SNRTP's policies. We recommend incorporating more hands-on training opportunities, implementing a mentorship model, setting tailored teaching sessions, and establishing resident wellness programs. We hope this study initiate dialogue on promoting residents' satisfaction and overall well-being.

Digital Ischemia in an Extreme Preterm Infant Treated with Nitroglycerin Patch.

Ischemic limb lesions occasionally occur in neonates admitted to neonatal intensive care units. Known risk factors include the placement of arterial catheters, arterial punctures to obtain blood samples, and the use of vasoactive/vasopressor medications for hypotension. Prolonged peripheral tissue ischemia may result in serious complications, and successful management depends on early detection, proper assessment, and the institution of appropriate intervention. Currently, there is no standard approach for the management of peripheral tissue ischemia in extreme preterm infants. Topical nitroglycerine use is one of the promising options used to manage ischemic limb injuries in neonates, as demonstrated in several case reports. We report a case of digital ischemia in an extreme preterm infant with no clear risk factors except extreme prematurity, which recovered after topical nitroglycerine therapy.

Prevalence of Selective Serotonin Reuptake Inhibitor Use Among Pregnant Women From 2017 to 2020 in King Abdulaziz Medical City, Jeddah, Saudi Arabia: A Retrospective Study.

BACKGROUND: Perinatal depression is a mental health disorder that is associated with feelings of hopelessness, despair, and lack of motivation. Its effects on pregnant women are not limited to hemorrhage and hypertension and may lead to maternal mortality. As a result, maternal antidepressant usage during pregnancy has rapidly increased in the United States. Selective serotonin reuptake inhibitors (SSRIs) are considered one of the most prescribed antidepressants. Thus, this study aims to measure the prevalence of SSRI use during pregnancy. METHODS: A retrospective cross-sectional study was carried out in King Abdulaziz Medical City, Jeddah (KAMC-J), Saudi Arabia. The population consisted of all pregnant women aged 18 or older from the period of January 2017 to December 2020 (N=13484). The sampling technique was non-probability consecutive sampling. RESULTS: The study included 13,484 pregnant women, and further analysis revealed that 62 (0.459%) were exposed to at least one type of antidepressant during pregnancy. Of these, 12 (19.35%) had used more than one class of antidepressants. The majority of the sample, comprising 39 (62.90%) women, were between 34 and 44 years old. Furthermore, SSRIs were found to be the most commonly used antidepressant (41, 66.13%). In addition, fluoxetine was the most frequently prescribed antidepressant, with 23 (37.10%) patients receiving this medication. The dosage did not exceed 20 mg for the majority of the patients on SSRIs. CONCLUSION: This study measured the prevalence and patterns of SSRIs and use of different antidepressant classes during pregnancy. After calculating the prevalence of each class of antidepressants among 62 pregnant women exposed to antidepressants, the analysis concluded that SSRIs are the most prescribed antidepressant during pregnancy. This study contributes to the growing body of literature on the use of antidepressants during pregnancy and highlights the need for ongoing research in this area.

Community pharmacists' perspectives on cardiovascular disease pharmaceutical care in the United Arab Emirates: a questionnaire survey-based analysis.

Background: Community pharmacists play an intermediary role between prescribing physicians and patients in the United Arab Emirates (UAE) and thus are responsible for ensuring that patients receive optimal cardiovascular disease (CVD) pharmaceutical care. Methods: we used a cross-sectional design to assess the perceptions and practices of community pharmacists concerning pharmaceutical care for patients with CVD. A trained researcher visited randomly selected community pharmacies and used a structured questionnaire to conduct in-person interviews with pharmacists. The questionnaire collected demographic data and information on perceptions and practices regarding CVD pharmaceutical care. Results: Five hundred and fifty-one participants were recruited. The average participant age (mean ± SD) was 35 ± 2.7 years. The average perception score regarding CVD prevention and management was 75.6% (95% confidence interval [CI] 77.1%-74.2%), and the average practice score for CVD prevention and management was 87.1% (95% CI 76.5%-79.6%). Bivariate analysis revealed that gender (p = 0.001), education level (p < 0.001), pharmacy position (p = 0.004), work experience (p < 0.001), number of patients served per day (p < 0.001) and being trained on CVD prevention and management (p < 0.001) were significantly associated with perceptions about the prevention and management of CVD. Better practice scores were seen among older participants (OR 1.01; 95% CI 1-1.019), postgraduates (OR 1.77; 95% CI 1.66-1.89), workers at chain pharmacies (OR 1.24; 95% CI 1.11-1.39), pharmacists in charge (OR 1.22; 95% CI 1.01-1.47), pharmacists with >10 years of experience (OR 11.3; 95% CI 6.01-15.62), pharmacists with 6-10 years of experience (OR 4.42; 95% CI 3.90-5) and pharmacists trained on CVD prevention and management (OR 1.29; 95% CI 1.15-1.46). Conclusion: Pharmacy practitioners working in community pharmacies in the UAE actively engage in delivering pharmaceutical care to patients, playing a role in CVD management and prevention. However, they showed low levels of involvement in other healthcare services, specifically in screening and measuring patients' weight, glucose levels, and blood pressure, monitoring treatment responses, maintaining medical records, and reviewing medication refill histories. Activities such as educating patients, providing medication counseling, offering support for treatment adherence, and fostering collaborative relationships with other healthcare providers should be encouraged among UAE community pharmacists to ensure the provision of high-quality patient care.

The Awareness and Practice of Self-Medication Among the General Public in Jeddah and Makkah.

Background Self-medication (SM) can be defined as the improper practice of obtaining and consuming a pharmaceutical drug without the consultation or prescription of a licensed physician. This includes evaluating the intensity of signs and symptoms which could lead to treating oneself with a medicine or seeking urgent medical care. Although SM can be deemed as safe for one's health, drug accessibility accounts for an irrational choice of medicines and thus exposes oneself to the adverse effects of these medicines. Several regional studies have provided sufficient evidence about how SM has commonly been practiced and held in some settings, such as pharmacies. Aim In this study, we aimed to assess the practice and awareness of SM in the general public. Thus, we utilized a questionnaire-based survey to analyze SM awareness and practice among the general population in Jeddah and Makkah. In addition, we examined the impact of demographic variables, such as educational level, economic status, age, etc. on SM practice. Methods A cross-sectional survey was distributed via social media platforms in June 2020. The study included Jeddah and Makkah's general public, all different nationalities, and both genders, and it excluded participants below the age 18-year-old and with mental and cognitive instability. After extrapolating the sample size at a 95% confidence level with an estimated 50% response distribution, a margin of error ±5%, and accounting for a 5% non-response rate, the estimated sample size was determined to be 404. Results A total of 642 participants completed the online-based survey, but only 472 responses fit the study criteria. Most of the participants (64.6%) did not consult with a physician, i.e., practiced SM, whereas (34.5%) have visited a doctor. Furthermore, people who did not visit a doctor had the commonest belief (26.1%) that they did not need a doctor to investigate their symptoms. The awareness of SM among the general public in Makkah and Jeddah was assessed by asking whether they deem this practice harmful, harmless, or beneficial. 65.9% of the participants deemed the practice of SM as harmful, and 17.6% regarded the act as harmless. Conclusion This study revealed that 64.6% of the general public of Jeddah and Makkah practice self-medication, even though 65.9% deemed this act harmful. The contradiction between the public's opinion and the actual behavior towards self-medication implies the need for more awareness of self-medication and the importance of exploring the incentives of such behavior.

Altered Pharmacokinetics Parameters of Vancomycin in Patients with Hematological Malignancy with Febrile Neutropenia, a Bayesian Software Estimation.

The pharmacokinetics of vancomycin vary significantly between specific groups of patients, such as critically ill patients and patients with hematological malignancy (HM) with febrile neutropenia (FN). Recent evidence suggests that the use of the usual standard dose of antibiotics in patients with FN may not offer adequate exposure due to pharmacokinetic variability (PK). Therefore, the purpose of this study is to assess the effect of FN on AUC0-24 as a key parameter for vancomycin monitoring, as well as to determine which vancomycin PK parameters are affected by the presence of FN using Bayesian software PrecisePK in HM with FN. This study was carried out in King Abdulaziz Medical City. All adult patients who were admitted to the Princess Norah Oncology Center PNOC between 1 January and 2017 and 31 December 2020, hospitalized and received vancomycin with a steady-state trough concentration measured before the fourth dose, were included. During the trial period, 297 patients received vancomycin during their stay at the oncology center, 217 of them meeting the inclusion criteria. Pharmacokinetic parameters were estimated for the neutropenic and non-FN patients using the precise PK Bayesian platform. The result showed that there was a significant difference (p < 0.05) in vancomycin clearance Clvan, the volume of distribution at a steady-state Vdss, the volume of distribution for peripheral compartment Vdp, half-life for the elimination phase t½ß, and the first-order rate constant for the elimination process ß in FN compared to non-FN patients. Furthermore, AUC0-24 was lower for FN patients compared to non-FN patients, p < 0.05. FN has a significant effect on the PK parameters of vancomycin and AUC0-24, which may require specific consideration during the treatment initiation.

The lasting impact of COVID-19 on surgical training from the perspective of surgical residents and consultants in Saudi Arabia: a nationwide cross-sectional study.

BACKGROUND: Since the start of the COVID-19 pandemic, many precautionary measures have been set to curb the transmission of the virus. That has led to changes, most notably in surgical education, like lack of surgical exposure and clinical activities. However, the question aiming at the impact of changes made by the COVID-19 pandemic on surgical education and its extent remains unanswered. MATERIALS & METHODS: An electronic survey was distributed among surgical residents and consultants from all over Saudi Arabia, starting from the 6th till the 21st of July, 2021. Descriptive statistics were presented using counts and proportions (%). Study subjects were compared with the different perspectives during the COVID-19 pandemic by using Chi-square test. A p-value cut-off point of 0.05 at 95% CI was used to determine statistical significance. RESULTS: A total of 243 out of 500 surgical residents and consultants responded to the survey, giving a response rate of 48.6%. The majority were general surgeons (50.5%) and cardiothoracic surgeons (21.8%). Nearly 66% of surgeons, both residents and consultants, strongly agreed on the importance of training for infectious disease outbreaks. 44.7% of the consultants and 48% of the residents showed their willingness to respond to the pandemic regardless of its severity. Over 70% of surgeons agreed that developing clinical skills was compromised by the COVID-19 pandemic, and 40% expected a negative impact of the COVID-19 on their operative skills. Simulation was ranked best for disaster medicine training by over 77% of the respondents. The most common concern among surgeons during the COVID-19 pandemic was their family's health and safety. Regarding virtual curriculum components, online practice questions and surgical videos were preferred by the surgical consultant and resident, respectively. CONCLUSIONS: Although the COVID-19 pandemic has impacted surgical education, it has highlighted the alarming need for adopting new components. For surgical training programs, we recommend improving the virtual curriculum, incorporating disaster medicine training, providing psychological services, and prioritizing immunization and treatment access for surgeons' families.

The effect of COVID-19 pandemic on respiratory therapy students' clinical practice: a cross-sectional study.

BACKGROUND: Due to the 2019 Coronavirus disease (COVID-19) precaution, educational systems and learners' practices from all specialties have been negatively affected, especially university students. COVID-19 has a massive effect on the practice of allied health students. The students' hospital exposure has been severely affected by the cancelation of the clinical practice. This study aims to investigate the effect of COVID-19 pandemic on the clinical practice of respiratory therapy students in different universities around Jeddah, Saudi Arabia. METHODS: Analytical cross-sectional online questionnaire was distributed from August 2021 to November 2021 to respiratory therapy students. The study's sampling technique was non-probability consecutive, and the calculated sample size was 183 participants. The survey contained questions to identify the clinical exposure of the participants. The participants included RT students in their clinical training years from King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz University, and Batterjee Medical College in Jeddah. The survey evaluated the effects of the pandemic on students' clinical practice, confidence and clinical preparation, and education. RESULTS: A total of 187 respiratory therapy students completed the questionnaire. The results revealed that 145 (77.5%) of respiratory therapy students agreed that the pandemic had disrupted their clinical practice. The percentage of respiratory therapy students who felt that they were less confident and less prepared for the next academic year due to practical session cancellation was 141 (75.4%). Out of the total students, 135 (72.2%) students reported difficulty in connecting the clinical and theoretical part because of the pandemic. CONCLUSION: The majority of respiratory therapy students from the three universities similarly reported that the pandemic disrupted their practice and interfered with their ability to connect between clinical and theoretical part. Moreover, it had affected their confidence and preparedness for the next year.

Efficacy and safety of vesatolimod in chronic hepatitis B: A systematic review and meta-analysis.

BACKGROUND: Vesatolimod is a toll-like receptor (TLR) agonist that is thought to suppress chronic hepatitis B (HBV) infection. This systematic review aimed to assess the safety and efficacy of vesatolimod in treating chronic hepatitis B. METHODS: We included randomized clinical trials (RCTs) that assessed vesatolimod in patients with hepatitis B infection without hepatocellular carcinoma or liver transplantation and with reported levels of hepatitis B surface antigen (HBsAg) or liver transaminases post-intervention. We searched MEDLINE, SCOPUS, Springer, Google Scholar, ClinicalTrials.gov, and Cochrane Central Register of Clinical Trials for all related articles during May 2022. Two independent authors screened articles for inclusion, and discrepancies were resolved by consensus and a third reviewer. Two independent reviewers assessed studies included in this systematic review using the Critical Appraisal Skills Programme checklist for RCTs. RESULTS AND CONCLUSION: Only 4 were considered eligible from 391 articles identified through our search. All eligible studies did not report any clinically significant outcomes following the use of vesatolimod, as evidenced by the persistence of HBsAg. However, vesatolimod was associated with induction of interferon-stimulated genes (ISGs) and only mild side effects, warranting further studies to evaluate its potential for future use as a safe, tolerable anti-HBV medication. No significant differences were noted amongst trials included in either of Vesatolimod doses (Vesatolimod 1 mg, RR = 0.99, 95% CI 0.76-1.30, P = .95, I2 = 0%; Vesatolimod 2 mg, RR = 1.06, 95% CI 0.82-1.37, P = .66, I2 = 0%; Vesatolimod 4 mg, RR = 1.06, 95% CI 0.82-1.37, P = .66, I2 = 0%;), further suggesting its comparable safety in comparison to oral antiviral agents.

Prevalence of Etiological Factors in Adult Patients With Epilepsy in a Tertiary Care Hospital in the Western Region of Saudi Arabia: A Cross-Sectional Study.

Background Epilepsy is a chronic neurologic condition with different risk factors and genetic predispositions. It is characterized by the occurrence of an epileptic seizure. To our knowledge, most studies have focused on revealing epilepsy prevalence in Saudi Arabia, but the etiological prevalence is still not well-studied in the region. Thus, this research aims to raise awareness and provide more insights into the etiological prevalence of this disorder. Methodology A cross-sectional study was performed among 431 adult patients diagnosed with epilepsy in the Neurology Department at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Patients' data were retrospectively collected from electronic medical files covering the period between May 2016 and April 2021. Epilepsy etiologies were classified as suggested by the International League Against Epilepsy 2017. Results The most commonly identified seizures were generalized (25.3%) and focal (8.9%). However, 66.1% of seizure types were unidentifiable. The most common etiology was structural (42.9%), followed by genetic (7.2%), with strokes (24.3%) and tumors (23.8%) being the most prevalent structural etiologies. However, 47.6% of the patients were classified under unknown etiology. Conclusions This study suggested that epilepsy diagnosed as generalized was by far the most common seizure type in our cohort. Structural etiology was evident in most patients, with stroke being the highest presented etiology.

Factors influencing the mental health of caregivers of children with cerebral palsy.

Objectives: Caregivers of children with cerebral palsy have a huge burden which might affect their mental health. This study aimed to determine the different factors affecting the mental health of caregivers of children with cerebral palsy and to raise awareness among healthcare providers. Methods: A cross-sectional study was conducted among caregivers of children with cerebral palsy in National Guard Health Affairs-Jeddah, Saudi Arabia, using the Depression Anxiety Stress Scale-21, which is a validated questionnaire that assesses: depression, anxiety, and stress. This questionnaire was used to assess the mental health of the caregivers. In addition, factors that reflected the child's health condition, such as visual impairment, number of emergency department visits, and number of Pediatric Intensive Care Unit admissions were also reported to investigate the impact on the caregiver's mental health. Results: The study sample consisted of 40 caregivers, of which 72.5% were mothers. According to the Depression Anxiety Stress Scale-21 score, 12.5% (n = 5) of the caregivers had moderate depression scores, 10% (n = 4) revealed extremely severe depression, and 10% (n = 4) showed moderate anxiety. Furthermore, 12.5% (n = 5), 15% (n = 6), and 7.5% (n = 3) of the caregivers have scored as moderate, severe, and extremely severe stress levels, respectively. Caregivers' depression, anxiety, and stress scores were significantly (p ≤ 0.05) associated with the impact of vision of their dependent children, frequent hospital admissions, and frequent emergency department visits. Increased Pediatric Intensive Care Unit admissions in the past year were also significantly associated with higher caregiver anxiety scores. Conclusion: To the best of our knowledge, the dimension of caregivers' stress and anxiety and their association with the children's dependency level is not well documented in our region. Caregivers of children with cerebral palsy reported having mental health challenges associated with the children's visual impairment, frequent need for acute medical care, and hospital admissions. Healthcare workers should provide early and proactive planning of medical and social support for children with cerebral palsy and their families using a family-centered approach.

The Prevalence of Atypical Antipsychotics, Antidepressants, and Benzodiazepines Use in Dementia Patients in King Abdulaziz Medical City.

Background Dementia is a major neuropsychiatric disease defined by a progressive decline in cognitive functions. Atypical antipsychotics, antidepressants, and benzodiazepines are mainly prescribed for dementia. Many dementia pharmacological management options are associated with serious health risks. Therefore, this study aimed to determine the prevalence of antipsychotic, antidepressant, and benzodiazepine use in dementia patients in King Abdulaziz Medical City. Methodology A cross-sectional study was conducted at a tertiary hospital (King Abdulaziz Medical City, Jeddah) between December 2016 and January 2019. The participants were patients over the age of 65 years diagnosed with dementia. Data were collected from the medical records of the hospital after acquiring ethical approval. Patients with psychiatric diseases preceding the diagnosis of dementia, or patients with dementia-like symptoms as a side effect of any medications were excluded. The variables included were demographics, dementia subtypes, medications, and the presence or absence of chronic diseases. Results This study included 139 patients of whom 51.1% were males. The mean age was 82.8 ± 8.8 years. Moreover, 34.53% of the patients were prescribed medications for dementia management. Importantly, medications prescribed for dementia were classified as the following: atypical antipsychotics (20.86%), antidepressants (17.3%), and benzodiazepines (5%). The most commonly prescribed atypical antipsychotics were quetiapine (93.1%), risperidone (13.8%), and olanzapine (3.44%). For antidepressants, the most commonly prescribed medications for dementia were mirtazapine (62.5%), citalopram (45.8%), amitriptyline (8.3%), and paroxetine (4.2%). Moreover, most prescriptions for benzodiazepine were divided between lorazepam (71.4%), clonazepam (14.3%), and diazepam (14.3%). Conclusions This study's results were consistent with previous epidemiological studies that have been conducted worldwide regarding the increase in the use of antipsychotics and antidepressants, with the exception of benzodiazepines. To our knowledge, there is a lack of research regarding the medications prescribed in the geriatrics age group with dementia. Therefore, the outcomes of this study recommend initiating awareness campaigns among physicians, regarding the harm of using antipsychotics, especially for this age group. Lastly, future studies should focus on increased surveillance and evaluation of drug safety warnings in dementia patients to improve the outcomes of the intervention.

Antibacterial Resistance Patterns Among Common Infections in a Tertiary Care Hospital in Saudi Arabia.

Background The rapid emergence of antibiotic-resistant bacteria threatens the control of infectious diseases by reducing treatment effectiveness, prolonging illness duration, and increasing healthcare costs. This study aimed to identify the common rate of bacterial resistance against antibacterial agents in tertiary healthcare providers in Saudi Arabia. Methodology This retrospective cross-sectional observational study was conducted from May 2016 to December 2019 on 1,151 urinary tract infection (UTI) and respiratory tract infection (RTI) positive cultures collected from participants aged 15 years or older who received antibiotic treatment. The obtained variables included age, gender, diagnosis, antibiotic type, specimen source, culture results, and sensitivity test results. Results The most common bacteria in UTI were Escherichia coli (46.7%), followed by Klebsiella pneumoniae (30.5%). Moreover, E. coli was most resistant to ampicillin (56.4%), followed by ceftriaxone (33.8%). Among the respiratory cultures, the most frequently isolated pathogen was Pseudomonas aeruginosa (28.5%), followed by K. pneumoniae (17.6%). The 162 respiratory P. aeruginosa isolates were most resistant to piperacillin/tazobactam (51.9%), followed by ciprofloxacin (25%) and ampicillin (10.6%). Conclusion High levels of antibiotic resistance were observed in both Gram-negative and Gram-positive bacteria. This indicates a need for better implementation of antibacterial stewardship and increased awareness of appropriate antibiotic use to limit the rapid spread of antibacterial resistance.

Clinical Identification of Hypovitaminosis D among Elderly Attending Primary Care Centre in Saudi Arabia.

Background: A large proportion of elderly people suffer from hypovitaminosis D, and depending on the severity of the condition, they develop complications that are detrimental to their health. Objective: To determine the consistency between the results of the vitamin D level in the blood compared to the result with the score of a simple questionnaire (Physician Vitamin D Status Predictor - VDSP) for elderly patients. Subjects and methods. This is a cross-sectional study conducted during the period between October 2018 and November 2019 in 3 primary health care centres (PHCCs) in Jeddah, Saudi Arabia. The subjects for this study were patients aged 60 or older. Data were collected in two phases: a questionnaire approach as the first phase, while the second phase involved blood testing for vitamin D levels. The validated questionnaire used in this study was the Physician`s Vitamin D Status Predictor (VDSP). Results: The study included 335 participants who ranged between 60 and 107 years old with a mean age of 68.2 years and standard deviation (SD) of 7.3 years. Females represented 66.9% of the total participants. The prevalence of vitamin D deficiency was 60.8%; among them, 7.2% were categorized as severe deficiency, whereas the prevalence of vitamin D insufficiency was 29.9%. The outcomes of VDSP survey were not directly associated with serum 25(OH)D levels in elderly people, except for the number of medications. In addition, vitamin D supplementation was associated with serum 25(OH)D levels among those patients. Conclusion: Vitamin D supplementation was significantly associated with serum 25(OH)D levels. Moreover, this study showed a significant association between serum 25(OH)D levels and the number of medications taken by the participants.

Augmented Renal Clearance and Hypoalbuminemia-Induced Low Vancomycin Trough Concentrations in Febrile Neutropenic Patients With Hematological Malignancies.

INTRODUCTION: Vancomycin administration in individuals with hematological malignancy or neutropenia is associated with a suboptimal trough concentration. Nonetheless, most studies did not distinguish whether low vancomycin trough concentrations were due to hematological malignancies or neutropenia. This study aimed to determine the association between types of hematological malignancy and febrile neutropenia with low vancomycin concentrations. METHODS: The present retrospective chart review study was conducted by using clinical data adopted from computerized physician order entries (BestCare®) for all of the patients who received intravenous vancomycin treatment between January 2017 and December 2020 at King Abdulaziz Medical City in Jeddah. RESULTS: Out of the 296 patients, 217 were included. There was no significant association between the type of hematological malignancy and the incidence of a low trough concentration (p > 0.05), while a significant association between febrile neutropenia and the incidence of a low trough concentration was observed (p < 0.05). Furthermore, the predictors for a low trough among febrile neutropenic patients were creatinine clearance (CrCI) and a low albumin concentration. In addition, there was a significant association between febrile neutropenia and augmented renal clearance (p < 0.05). CONCLUSIONS: The findings of this study conclude that febrile neutropenia is associated with low vancomycin concentrations. Interestingly, augmented renal clearance was observed in most of the febrile neutropenia patients with a significant association, which is considered the main driver for a low trough in neutropenic patients.

Level and predictors of breast cancer awareness among Saudi women: A nationwide study.

BACKGROUND: Breast cancer occurs when abnormal breast cells grow rapidly and uncontrollably. Early detection and intervention have been established to significantly decrease mortality rates. OBJECTIVE: There is a lack of focused research investigating the degree of breast cancer awareness among Saudi women. Thus, this study aimed to fill this gap by conducting a nationwide survey on a large pool of women. DESIGN: A cross-sectional web-based nationwide study. METHODS: This study targeted Saudi women from all regions of the country and was conducted from 20 August to 3 September 2021. The study used the Breast Cancer Awareness Measure questionnaire to measure breast cancer awareness. This study was approved by the King Abdullah International Medical Research Center institutional review board. RESULTS: Overall, poor breast cancer awareness scores were demonstrated by 71% of the participants. Unemployed women were more likely to have poor breast cancer awareness. CONCLUSION: Our study reports an alarmingly high level of poor overall breast cancer awareness in Saudi women. Interventions should be implemented to combat this lack of awareness.

Knowledge, attitudes, and perception toward human papillomavirus among health profession students: A cross-sectional study in King Saud Bin Abdulaziz University for Health Sciences.

BACKGROUND: Human papillomavirus (HPV) infection is the major risk factor for cervical cancer (CC) in women of reproductive age. Despite advances in treatment and prevention of CC by HPV vaccination, very few women utilize them because of a lack of awareness about HPV. MATERIALS AND METHODS: We conducted this cross-sectional study among Health Professions Students (HPS) at King Saud Bin Abdul Aziz University for Health Sciences, Jeddah. Data were collected using a predesigned and validated study questionnaire to assess the knowledge, attitude, and perception of HPS toward HPV. RESULTS: A total of 580 HPS responded to the survey; 128 (22.1%) were male, while 452 (77.9%) were female with the mean age ± standard deviation 20.36 ± 1.74 years. There was no significant difference between males and females related to screening of HPV and CC (82.8%; 82.3%). A minority (30.3%) of participants thought that HPV infection leads to CC, while 38.3% did not know about it. Furthermore, knowledge about HPV screening and vaccination was poor. CONCLUSIONS: Students from the college of medicine had more knowledge and awareness about HPV (34.9%, P < 0.001). Thus, it is important to implement effective education programs, curricular activities, and awareness campaigns for health professions to augment the learning process effectively.

The Association Between Antipsychotics and Weight Gain and the Potential Role of Metformin Concomitant Use: A Retrospective Cohort Study.

Background: Obesity and its complications are associated with several adverse effects that may cause a serious impact on health. Antipsychotics-induced weight gain (AIWG) is one of the major, yet often neglected side effects of first and second generations antipsychotics. Importantly, several researches have shown metformin to be effective in managing weight gain especially, with AIWG. This study investigated the effect of antipsychotics use on weight gain and the theory of metformin concomitant use on the prevention of AIWG. Methods: A retrospective cohort review of the medical records of patients from the psychiatry outpatient clinics in the King Abdulaziz Medical city, a tertiary hospital in Jeddah from May 2016 to August 2021. The population of patients in Psychiatry section was 4,141. The sampling technique was a non-random consecutive sampling technique. Moreover, the included patients' records were divided to group 1 (patients on antipsychotics) and group 2 (patients using antipsychotics with Metformin). Results: According to the study criteria, 395 patients' records were included. A total of 309 (78%) patients were using antipsychotics without metformin, which in this study were depicted as group 1. In addition, a total of 86 (22%) were using antipsychotics with metformin, which in this study were assigned as group 2. Out of Group 1 patients (n = 309), only 67 patients experienced weight loss (21.68%), 43 remained with no weight change (13.92%), and 199 experienced weight gain (64.4%). Out of Group 2 patients (n = 86), 35 patients experienced weight loss (40.7%), 18 patients remained with no weight change (20.93%), and 33 experienced weight gain (38.37%). In addition, group 1 had a mean weight change of 2.5 kg, whereas group 2 had a mean weight change of -0.04 kg. Conclusion: Statistical analysis revealed that patients on antipsychotics alone experienced weight gain, whereas the concomitant use of metformin showed reduction in the weight gain tendency. Thus, study outcomes indicate that concomitant use of metformin with antipsychotics might significantly reduce the AIWG.