Antigenic drift of hemagglutinin and neuraminidase in seasonal H1N1 influenza viruses from Saudi Arabia in 2014 to 2015.

Antigenic drift of the hemagglutinin (HA) and neuraminidase (NA) proteins of the influenza virus cause a decrease in vaccine efficacy. Since the information about the evolution of these viruses in Saudi is deficient so we investigated the genetic diversity of circulating H1N1 viruses. Nasopharyngeal aspirates/swabs collected from 149 patients hospitalized with flu-like symptoms during 2014 and 2015 were analyzed. Viral RNA extraction was followed by a reverse transcription-polymerase chain reaction and genetic sequencing. We analyzed complete gene sequences of HA and NA from 80 positive isolates. Phylogenetic analysis of HA and NA genes of 80 isolates showed similar topologies and co-circulation of clades 6b. Genetic diversity was observed among circulating viruses belonging to clade 6B.1A. The amino acid residues in the HA epitope domain were under purifying selection. Amino acid changes at key antigenic sites, such as position S101N, S179N (antigenic site-Sa), I233T (antigenic site-Sb) in the head domain might have resulted in antigenic drift and emergence of variant viruses. For NA protein, 36% isolates showed the presence of amino acid changes such as V13I (n = 29), I314M (n = 29) and 12% had I34V (n = 10). However, H257Y mutation responsible for resistance to neuraminidase inhibitors was missing. The presence of amino acid changes at key antigenic sites and their topologies with structural mapping of residues under purifying selection highlights the importance of antigenic drift and warrants further characterization of recently circulating viruses in view of vaccine effectiveness. The co-circulation of several clades and the predominance of clade 6B.1 suggest multiple introductions in Saudi.

Insights of Healthcare Professionals into Medical Writing Support at a Tertiary Care Hospital in Saudi Arabia.

BACKGROUND AND AIMS: The demand for medical writing is on the rise in academic and medical entities worldwide. However, a huge disparity in the perception of professional medical writing arises from inadequate education and regularity in service quality and potential ethical challenges. Hence, we aimed to examine the knowledge, attitude, and perception toward professional medical writing support (PMWS) of healthcare professionals at King Fahad Medical City (KFMC). METHODS: An observational cross-sectional study was conducted using a questionnaire that was validated for its accuracy and clarity by an expert panel in academic integrity. The self-administered questionnaires were distributed to 200 healthcare professionals from a broad range of specialties throughout KFMC. The socio-demographic characteristics and healthcare professionals' knowledge, attitudes, and perceptions were recorded. The responses were quantitatively evaluated using a 5-point Likert Scale and analyzed using the Statistical Package for Social Sciences 25 (IBM, New York, United States). RESULTS: 162 healthcare professionals in KFMC filled in the questionnaire completely. Most respondents agreed that it was acceptable for medical writers to help with writing publications and that they offered a valuable service. Concerning association with socio-demographic characteristics, the mean score of knowledge was found to be significantly related to those with age ≥45 years (p<0.001), PhD degree (p=0.044), >5 years of research experience (p<0.001), and being a faculty/consultant (p=0.005). No significant association was found with the mean total score of attitude. Participants having >5 years of research experience were found to have a higher significant level of perception (p=0.004). CONCLUSIONS: Our study highlights that PMWS is relatively well-utilized and perceived positively within KFMC. There is a need for further research and education of ethics regarding the use of PMWS.

Flaring Inflammation and ER Stress by an Organelle-Specific Fluorescent Cage.

The endoplasmic reticulum (ER) plays an important role in protein synthesis and its disruption can cause protein unfolding and misfolding. Accumulation of such proteins leads to ER stress, which ultimately promotes many diseases. Routine screening of ER activity in immune cells can flag serious conditions at early stages, but the current clinically used bio-probes have limitations. Herein, an ER-specific fluorophore based on a biocompatible benzothiadiazole-imine cage (BTD-cage) with excellent photophysical properties is developed. The cage outperforms commercially available ER stains in long-term live cell imaging with no fading or photobleaching over time. The cage is responsive to different levels of ER stress where its fluorescence increases accordingly. Incorporating the bio-probe into an immune disorder model, a 6-, 21-, and 48-fold increase in intensity is shown in THP-1, Raw 246.7, and Jurkat cells, respectively (within 15 min). These results strongly support that this system can be used for rapid visual and selective detection of ER stress. It is envisaged that tailoring molecular interactions and molecular recognition using supramolecular improved fluorophores can expand the library of biological probes for enhanced selectivity and targetability toward cellular organelles.

Comprehension of premarital screening and genetic disorders among the population of Riyadh.

Objective: Premarital, unfortunately, does not cover all possible genetic diseases, such as deafness and congenital heart diseases, diabetes mellitus, and hypertension, nor does it cover unknown genetic mutations that may cause severe defects in subsequent generations. However, the Saudi population has limited knowledge regarding premarital screening tests, which do not detect all genetic disorders or diseases. Hence, we aimed to explore the knowledge and attitudes among the population of Riyadh toward premarital screening. Methods: A cross-sectional observational study was conducted with a self-administered designed questionnaire. The survey included questions regarding sociodemographic data, genetics, genetic testing, and premarital screening. All data were entered and analyzed in the statistical package SPSS version 22. Results: A total of 385 participants responded to the questionnaire, and good knowledge among most participants was significantly associated with education level (p < 0.001), sex (p < 0.001), and prior screening (p = 0.001). The overall attitude was positive toward premarital screening, and significant associations of sex and social/marital status with a positive response to premarital screening were observed. Conclusion: Knowledge and attitudes among the population of Riyadh toward premarital screening must be improved through national awareness programs. In light of our results, a need exists to provide more information and education regarding screening. Further studies must be conducted in urban areas to investigate the level of satisfaction with existing programs.

Health care professionals' knowledge and attitudes toward telemedicine.

Background: The utilization of modern communication technology in the healthcare field is known as telemedicine, and it represents an advancement in the healthcare industry. For effective implementation of these technologies, healthcare professionals must possess the appropriate knowledge and hold a positive perspective toward the implementation of telemedicine. The current study aims to evaluate the knowledge and perspective of healthcare professionals in King Fahad Medical City, Saudi Arabia toward telemedicine. Methods: This study was carried out in a diverse hospital, King Fahad Medical City, Saudi Arabia and it was a cross-sectional study. The study took place from June 2019 until February 2020, during which 370 healthcare professionals, including physicians, nurses, and other healthcare professionals participated. The data was gathered by using a structured self-administered questionnaire. Results: The analysis of the data revealed that the majority of the healthcare professionals who participated in the study, 237 (63.7%), had limited knowledge of telemedicine. About 41 (11%) participants had a good understanding of the technology, and 94 participants (25.3%) had extensive knowledge. The overall attitude of the participants toward telemedicine was positive, with a mean score of 3.26. The mean attitude scores varied significantly (P < 0.001) among the different professions, with physicians scoring 3.69, allied healthcare professionals scoring 3.31, and nurses scoring 3.07. The coefficient of determination (R2) was used to evaluate the variation in attitude toward telemedicine and it was found that education (12.4%) and nationality (4.7%) had the least impact on the attitude toward telemedicine. Conclusion: Healthcare professionals are crucial to the successful implementation and continuity of telemedicine. However, despite their positive attitude toward telemedicine, most of the healthcare professionals who participated in the study had limited knowledge of it. There were differences in attitude among different groups of healthcare professionals. As a result, it is necessary to create specialized educational programs for healthcare professionals to guarantee the proper implementation and continuation of telemedicine.

Cystic Renal Cell Carcinoma Subtype in Pediatric Patient: A Case Report.

A 10-year-old boy presented with a right flank mass. Computed tomography, ultrasound scan, and magnetic resonance imaging confirmed the presence of a multiloculated cystic mass. After right kidney nephrectomy, the biopsy proved the diagnosis of cystic renal cell carcinoma, which is a rare subtype of renal cell carcinoma in the pediatrics age group. The knowledge about this incidence can optimize the investigations, management, and outcomes.

Interaction of SARS-CoV-2 with cardiomyocytes: Insight into the underlying molecular mechanisms of cardiac injury and pharmacotherapy.

SARS-CoV-2 causes respiratory illness with a spectrum of systemic complications. However, the mechanism for cardiac infection and cardiomyocyte injury in COVID-19 patients remains unclear. The current literature supports the notion that SARS-CoV-2 particles access the heart either by the circulating blood cells or by extracellular vesicles, originating from the inflamed lungs, and encapsulating the virus along with its receptor (ACE2). Both cardiomyocytes and pericytes (coronary arteries) express the necessary accessory proteins for access of SARS-CoV-2 particles (i.e. ACE2, NRP-1, TMPRSS2, CD147, integrin α5ß1, and CTSB/L). These proteins facilitate the SARS-CoV-2 interaction and entry into the pericytes and cardiomyocytes thus leading to cardiac manifestations. Subsequently, various signaling pathways are altered in the infected cardiomyocytes (i.e. increased ROS production, reduced contraction, impaired calcium homeostasis), causing cardiac dysfunction. The currently adopted pharmacotherapy in severe COVID-19 subjects exhibited side effects on the heart, often manifested by electrical abnormalities. Nonetheless, cardiovascular adverse repercussions have been associated with the advent of some of the SARS-CoV-2 vaccines with no clear mechanisms underlining these complications. We provide herein an overview of the pathways involved with cardiomyocyte in COVID-19 subjects to help promoting pharmacotherapies that can protect against SARS-CoV-2-induced cardiac injuries.

Acute Inflammatory Pericarditis following First Dose of COVID-19 Vaccine (AstraZeneca).

Background: Clinical trials of the COVID-19 vaccine reported the safety and efficacy of mRNA vaccines (AstraZeneca) to help control the disease. Few previous reports have shown various side effects associated with COVID-19 vaccines that vary in severity. The possibility of pericarditis and myocarditis has been observed in people who have received an mRNA COVID-19 vaccine which we are reporting. Acute inflammatory pericarditis can be a rare presentation after receiving the first dose of this vaccine, and it is enriching to share such rare presentations in the era of COVID-19 for better management and outcomes after vaccination. Case Presentation. This is a case of acute inflammatory pericarditis with a small pericardial effusion after receiving the first dose of AstraZeneca COVID-19 vaccine in a healthy adult patient who had no other symptoms suggestive of other viral illness in addition to the negative COVID-19 PCR. A 48-year-old healthy male presented nine days after receiving the first dose of COVID-19 AstraZeneca vaccine. The symptoms started three days after the vaccine, when he complained of progressive retrosternal chest pain with low-grade fever and generalized fatigue, followed by exertional dyspnea after a few days. The diagnosis of acute inflammatory pericarditis with small pericardial effusion was established, and the patient was accordingly treated. One week later, the patient showed significant clinical improvement with the resolution of his pericardial effusion. After 39 days, there was a significant radiological resolution of signs of acute pericarditis. Conclusion: The ongoing COVID-19 outbreak is still under investigation, and guidelines are regularly modified since we are continuously learning about this novel disease, although multiple vaccines have been shown to be effective against COVID-19. However, we report a case of unique clinical manifestation that has not been reported widely in the literature, after receiving the first dose of AstraZeneca COVID-19 vaccine, and that it may help raise awareness of the possible diagnosis and the possibility of inflammatory pericarditis after COVID-19 vaccination.

Association of chromosome 6 open reading frame 106 in different cancers.

Introduction: Cancer is the leading cause of death globally according to WHO in 2020. It is initiated by genetic mutations that occur due to numerous factors. The aim of the review: This review provides a clear view of the potential use of chromosome 6 open reading frame 106 (C6orf106) as a biomarker, based on previous studies. Results: Recent studies have investigated the association of C6orf106 with breast cancer and non-small cell lung cancer and showed that silencing C6orf106 leads to inhibition of malignancy in both diseases, as well as showing a positive correlation between C6orf106 expression and malignancy. Other studies demonstrated the interaction of C6orf106 with other malignancy factors that play a role in many cancer types, such as cyclin A2, cyclin B1, N-cadherin, E-cadherin, c-MYC, p120ctn, and vimentin. These factors play a significant role in cellular adhesion and the regulation of the cell cycle. C6orf106 is a potential target for numerous cancers, not only non-small cell lung cancer and breast cancer. In conclusion: understanding the connection of C6orf106 with crucial malignancy factors makes it clear that C6orf106 is a potential therapeutic target and diagnostic biomarker for many disease cancer.

Patient satisfaction with the emergency department services at an academic teaching hospital.

INTRODUCTION: Healthcare reform efforts focus on patient-centered care is measured by patient satisfaction. Emergency department (ED) satisfaction ratings are often the lowest. Since ED is the first point of contact for the patient care to receive primary care, we aimed to explore patient satisfaction related to ED healthcare services at our institution. METHODS: In this cross-sectional study, ED-CAHPS, a standardized validated nine-item survey questionnaire, was administered via telephonic interviews to Arabic-speaking patients who attended ED at our institution. Patient demographics, ED operation parameters, and healthcare utilization factors were evaluated as patient satisfaction predictors. RESULTS: Out of 713 patients who were contacted 200 patients responded to the survey. In all, 70% of respondents were aged 35-64 years and 55% had secondary or higher education levels. The dimension average for the questions regarding arrival, waiting time, and urgency of treatment was 36%. Regarding satisfaction with pain management was 42%, medication information was 34% and interpreter services were only 40%. The overall dimension average for satisfaction regarding nursing care was 43%, doctor care was 36%. The overall dimension average for satisfaction regarding the discharge process was 56%. The highest scores were observed for whether the patients were asked about follow-up care (61%), whether they understood the symptoms to look for after leaving the ED (58%), and whether they received care within 30 min of arriving at the ED (56%). On the other hand, the worst scores were recorded for whether the patients were made to understand regarding the side effects of new medications (29%), whether nurses spent enough time with them (33%), and whether doctors spent enough time with them (34%). CONCLUSIONS: Based on these results, recommendations were made to improve patients' perceptions/experience in receiving the care and the overall rating. This study presents specific recommendations for maximizing patient satisfaction in primary ED settings in Saudi Arabia.

Clinical outcomes of maternal and neonate with COVID-19 infection - Multicenter study in Saudi Arabia.

BACKGROUND: To this end, the influence of COVID-19 on pregnant women and their neonates is not completely clear. Therefore, the main aim of this study is to investigate maternal and neonatal clinical outcomes with confirmed COVID-19 infection. Besides, it investigates the likelihood of vertical transmission of COVID-19 infection from pregnant women to their neonates. METHODS: A retrospective descriptive study was conducted in three medical centers during the period from March to November 2020. Data were collected from the available medical records in the respective hospitals using a standardized questionnaire on maternal and neonatal clinical outcomes. All pregnant women with confirmed COVID-19 infection across the three hospitals and their neonates were eligible to participate in this study. Descriptive statistics were presented as a median and interquartile range (IQR) or frequencies and percentages as appropriate using SPSS 24.0 software. RESULTS: This study has identified a total of 288 pregnant women with confirmed COVID-19 infection over the study period of a median age of 30 years and median GA at diagnosis 38 weeks (IQR: 39 -33) as well as 27% of them were obese (n=78). The majority of pregnant women were symptomatic with cough (n=92, 31.9%) being the most frequent COVID-19 symptom followed by fever and dyspnea (n=36, 12.5%). Two-hundred and four pregnant delivered (70.84%) and caesarean sections were prevalent among 35.8% of them. The most common adverse pregnancy outcome was premature (n=31, 15.5%), followed by fetal distress (n=13, 6.5%), preeclampsia (n=4, 2.0%), and one pregnant woman died. The laboratory results exhibit that temperature higher than 38 (n=27), leukopenia (n=19), neutropenia (n=54), ALT (n=12), AST (n=31), and thrombocytopenia (n=35) were less frequent among pregnant women while lymphopenia (n=126), hemoglobin levels lower than 13.0 (n=218), deceased albumin levels (n=195) were most frequent among them. However, a small proportion of pregnant women were admitted to the ICU (3.8%). The most frequent maternal treatments were antibiotics (n=81), antiviral (n=49), and corticosteroid (n=24). Of 204 neonates, four had died and all the remaining neonates were alive. The median gestational age at delivery was 39 weeks (IQR: 35-40). Most neonates had normal laboratory results. However, 14 had lymphopenia (7.0%), 22 had neutropenia (11.0%), and 11 had thrombocytopenia (5.5%). Four infants had low hemoglobin levels of less than 13.0 (2.0%) and 81 had hyperbilirubinemia (e.g., total bilirubin of higher than 23; 40.5%). Approximately less than one-half of neonates required admission to the NICU (n=86, 43%), 7% of them required respiratory support of mechanical ventilation, and none of them get infected with COVID-19 disease. CONCLUSION: This multicenter study suggests that the majority of pregnant women had mild or moderate disease symptoms. Nevertheless, this study did not find any evidence of possible vertical transmission of COVID-19 infection from mothers to their babies. This study may provide a baseline for further studies focusing on investigating long-term maternal and neonate's outcomes and possible vertical transmission of COVID-19 from mothers to their newborn babies.