Does illicit amphetamine seizures quantity associated with amphetamine use disorder related admissions in Saudi Arabia?

BACKGROUND: Illicit amphetamine-type stimulants (ATS) trafficking activities have increased substantially in Saudi Arabia over the last 10 years. In the period 2013-2017 Saudi Arabia seized the largest quantities of amphetamine at the global level. The current study examines whether the increased quantity of ATS seizures has an impact on amphetamine use disorder admissions. METHOD: This is an ecological study combining two datasets, the first dataset was obtained from United Nations Office on Drugs and Crime (UNODC), and the Al-Amal Hospital Electronic Health Record System in the city of Dammam, Eastern region of Saudi Arabia from 2005 to 2018. The annual incidence of patients diagnosed with amphetamine use was the dependent variable. The independent variable was the annual reported count of seized quantities of ATS in Saudi Arabia. We used a random intercept Negative Binomial model to predict the yearly count of amphetamine use disorder admission rates. RESULTS: A total of 910 amphetamine disorder admission patients in Al-Amal rehabilitation and addiction center, and the quantity equivalent to 200 tons of ATS was seized from 2005 to 2018. The amphetamine disorder admission rate has increased from 1.33% in 2005 to 18.27% in 2018. For each one-unit increase in the amphetamine confiscated quantities, the amphetamine use disorder admission rate increased by 49 to 88%. CONCLUSION: The current study found that reported amphetamine seized quantities were significantly and positively associated with the increase of amphetamine use disorder-related admission rates. In 2018, both ATS seized quantities and admission rates significantly increased, nearly doubling from the previous year. Rigorous, and multidisciplinary interventional studies to evaluate factors associated with increasing abuse of ATS should be a priority for policymakers and researchers in Saudi.

Aligning Provider Prescribing With Guidelines for Soft Tissue Infections.

OBJECTIVE: Despite evidence-based guidelines, antibiotics prescribed for uncomplicated skin and soft tissue infections can involve inappropriate microbial coverage. Our aim was to evaluate the appropriateness of antibiotic prescribing practices for mild nonpurulent cellulitis in a pediatric tertiary academic medical center over a 1-year period. METHODS: Eligible patients treated in the emergency department or urgent care settings for mild nonpurulent cellulitis from January 2017 to December 2017 were identified by an International Classification of Diseases, Tenth Revision, code for cellulitis. The primary outcome was appropriateness of prescribed antibiotics as delineated by adherence with the Infectious Diseases Society of America guidelines. Secondary outcomes include reutilization rate as defined by revisit to the emergency department/urgent cares within 14 days of the initial encounter. RESULTS: A total of 967 encounters were evaluated with 60.0% overall having guideline-adherent care. Common reasons for nonadherence included inappropriate coverage of MRSA with clindamycin (n = 217, 56.1%) and single-agent coverage with sulfamethoxazole-trimethoprim (n = 129, 33.3%). There were 29 revisits within 14 days of initial patient encounters or a reutilization rate of 3.0%, which was not significantly associated with the Infectious Diseases Society of America adherence. CONCLUSIONS: Our data show antibiotic prescription for nonpurulent cellulitis as a potential area of standardization and optimization of care at our center.

Effects of comorbid conditions and prescribed chronic medications on the treatment plan for chronic hepatitis C infection: A cross-sectional retrospective study.

Background: Chronic hepatitis C (CHC) infection is a potentially life-threatening condition characterized by various complications, including end-stage liver disease and cirrhosis. The mortality rate associated with CHC has been increasing due to the presence of comorbidities and the use of chronic medications. Therefore, the objective of this study was to investigate the impact of these comorbidities and chronic medications on the treatment plan for CHC. Methods: To achieve this objective, a cross-sectional retrospective study was conducted at a tertiary hospital in Jeddah, Saudi Arabia. The study population included patients aged 12 years and above who were diagnosed with CHC between 2016 and 2021. Patients below the age of 12 were excluded from the study. A total of 170 patients with CHC were included in the analysis. The study aimed to evaluate the relationship between CHC complications and the treatment approach. Results: The mean age of the study participants was 66.78 years, with a higher proportion of female patients. The findings revealed a significant association between hypertension (p = 0.042) and cirrhosis (p = 0.007) with changes in the treatment plan for CHC. Moreover, the presence of diabetes mellitus (p = 0.045), renal diseases (p < 0.001), and hypothyroidism (p = 0.004) were significantly associated with HCV clearance after the initiation of therapy. Additionally, the use of proton pump inhibitors (p = 0.033) and levothyroxine (p = 0.025) was found to be associated with a higher rate of CHC clearance. Conclusion: In conclusion, this study highlights the prevalence of comorbid conditions and the use of chronic medications among patients with CHC. The findings emphasize the importance of considering the effects of comorbidities and chronic medications when developing treatment plans for CHC infections. By taking these factors into account, healthcare professionals can optimize the management of CHC and improve patient outcomes.

Vaccine Hesitancy among Medical Students at a Tertiary Hospital-Affiliated Medical School.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) caused a global pandemic with long-lasting economic and cultural impacts. International governments have attempted to scale up vaccine production to mitigate this crisis. However, vaccine hesitancy, particularly among healthcare providers, remains an understudied subject that may hinder vaccine effectiveness. METHODS: We performed a cross-sectional study to evaluate vaccine hesitancy among medical students using a pre-validated survey based on the 5C model of psychological antecedents, which includes confidence, complacency, constraints, calculation, and collective responsibility. RESULTS: The majority of medical students had high scores for confidence (79.7%), non-complacency (88%), and not having constraints against receiving the COVID-19 vaccine (97.4%). Surprisingly, students had low scores for calculation (38%) and collective responsibility (14.7%). Many predictors of the psychological antecedents included in the 5C model have been reported, including academic year and gender. CONCLUSION: We observed moderate levels of vaccine hesitancy among the medical students included in our study. We urge medical students to be more aware of community public health concerns. We recommend that authorized institutions lay out urgent reforms to increase awareness of COVID-19 and available vaccines.

Bloodstream gram-negative bacterial infections in adult patients with leukemia: A retrospective review of medical records in a tertiary care hospital in Western Saudi Arabia.

BACKGROUND: Patients with neutropenic cancers are at high risk of acquiring infections, especially if on chemotherapy. Gram-negative bacterial infections are associated with high mortality. This study aimed to assess clinical characteristics, outcomes, and epidemiology of gram-negative bacterial (GNB) bloodstream infections (BSI) in adult patients with leukemia. METHODS: This single-center, retrospective study included 102 adult patients diagnosed with leukemia between 2017 and 2019. The patients' demographics, infection diagnosis, leukemia diagnosis, comorbidities, and infection outcomes were collected from electronic medical records. RESULTS: The most common GNB were Klebsiella pneumoniae (33.3 %), Pseudomonas aeruginosa (23.5 %), and Escherichia coli (17.6 %). Additionally, 36.7 % of infections were multidrug resistant. The most common comorbidities were cardiovascular diseases (36.7 %), diabetes mellitus (33.3 %), and liver diseases (24.1 %). GNB-infected patients had a higher mortality than noninfected patients (35.3 % and 11.8 %, respectively, p = 0.005). In a multivariable analysis, patients with acute myeloid leukemia and acute lymphoid leukemia were significantly more likely to acquire GNB BSI (p = 0.01), while patients with chronic myelogenous leukemia and chronic lymphocytic leukemia had a lower likelihood of developing GNB BSI. In addition, low hemoglobin level was an independent risk factor of GNB BSI (p = 0.001). Chemotherapeutic agents showed an association with increased risk of GNB BSI. CONCLUSIONS: Patients with acute leukemia and low hemoglobin levels have increased risk of GNB BSI, which was associated with increased mortality. Prospective studies are needed to further assess the effect of co-morbidities and chemotherapy medications on the occurrence of GNB BSI according to the type of leukemia.

Transition to remote/hybrid learning during the COVID-19 pandemic among Saudi students of the College of Applied Medical Sciences: a cross-sectional study.

Background: The novel Coronavirus Disease 2019 (COVID-19) pandemic has presented unparalleled and unique stressors and challenges to the field of applied health sciences education. This study explored how the College of Applied Medical Sciences (COAMS) Saudi students perceive the transition to remote/ hybrid learning during the COVID-19 pandemic. Methods: A cross-sectional exploratory investigation was carried out during the months of February and March in the year 2023 among 196- COAMS Saudi students, using the 48-item previously developed and validated questionnaire, and with a non-probability convenient sampling technique. Descriptive statistics were generated for participants' demographics, and for each questionnaire item and statistical analysis was performed using chi-square test. Results: Out of the 283 undergraduates who have enrolled in COAMS, a total of 196 students have agreed to participate in the study with an overall response rate of 69.3%. Over 70% of COAMS students were satisfied and engaged in their on-site coursework. Nevertheless, questionnaire data indicates that their satisfaction and level of engagement diminished following the shift to remote learning. More than 62% of COAMS students were satisfied with their instructors' instructional and assessment strategies during on-site coursework, but such perceptions have decreased with remote instruction. Hybrid learning can be beneficial and effective in improving the performance and learning experience of COAMS students. As compared to female students, COAMS male students were more satisfied with remote learning because it met their needs (p = 0.017). Conclusion: Remote classrooms have lower attendance and interest than on-site classes. Despite lower satisfaction levels in online courses, hybrid learning was viewed favourably by COAMS students. Higher educational institutions should develop plans to increase student involvement, improve academic integrity, and assess the effect of the pandemic on undergraduate education on a regular basis. By incorporating these measures, educational institutions can enhance and support the remote learning experience for their students.

The barriers, motives, perceptions, and attitudes toward research among radiology practitioners and interns in Saudi Arabia: a cross-sectional study.

Background: Research and the use of evidence-based practices are imperative to the advancement of diagnostic imaging modalities. The aim of this study was to assess the perceptions and attitudes of radiology practitioners (i.e., Technicians, Technologists or Specialists, and Senior Specialists) and interns in King Abdulaziz Medical Cities (KAMCs), Kingdom of Saudi Arabia, toward research, and to explore the various barriers and obstacles that hinder their research efforts. Methods: A cross-sectional descriptive investigation was carried out from December 2022 to March 2023 among 112-KAMCs' radiology practitioners and interns, using previously developed and validated questionnaire comprised of five distinct sections, each serving a specific purpose, and with a non-probability convenient sampling technique. Descriptive statistics were generated for participants' demographics, and chi-square and fisher's exact tests were used to examine the association between participants' demographics and their involvement in research. Results: Among the 137 KAMCs' radiology practitioners and interns who were invited to participate, 112 responded and completed the questionnaire, resulting in an overall response rate of 81.75%. Radiology practitioners and interns from various medical imaging subspecialties were found to be involved in research to the extent of 83%, with nearly half (40.9%) of them have had publications, and 53.3% of these publications being either cross-sectional studies or retrospective clinical studies. A lack of time (66.1%), a lack of a professional supervisor support program (50.9%), and deficiency in research skills (45.5%) were common obstacles that may impede the participants' ability to conduct research. The most common motives for participants to conduct research were the desire to improve their resumes (69.6%), get accepted into postgraduate radiology programs (58%), and improve their research skills (52.7%). Conclusion: KAMCs' radiology practitioners and interns have a positive attitude toward performing research. Despite the high percentage (83%) of those involved in research, the number of publications remains low. A crucial step to advancing the profession's evidence base is engaging radiology practitioners and interns in research and encouraging radiology practitioner-led research. The study findings can serve as a valuable basis for designing developmental programs aimed at overcoming research obstacles among healthcare professionals in Saudi Arabia.

Lung Function Decline in Cystic Fibrosis: Impact of Data Availability and Modeling Strategies on Clinical Interpretations.

Rationale: Studies estimating the rate of lung function decline in cystic fibrosis have been inconsistent regarding the methods used. How the methodology used impacts the validity of the results and comparability between studies is unknown. Objectives: The Cystic Fibrosis Foundation established a work group whose tasks were to examine the impact of differing approaches to estimating the rate of decline in lung function and to provide analysis guidelines. Methods: We used a natural history cohort of 35,252 individuals with cystic fibrosis aged ⩾6 years in the Cystic Fibrosis Foundation Patient Registry (CFFPR), 2003-2016. Modeling strategies using linear and nonlinear forms of marginal and mixed-effects models, which have previously quantified the rate of forced expiratory volume in 1 second (FEV1) decline (percent predicted per year), were evaluated under clinically relevant scenarios of available lung function data. Scenarios varied by sample size (overall CFFPR, medium-sized cohort of 3,000 subjects, and small-sized cohort of 150), data collection/reporting frequency (encounter, quarterly, and annual), inclusion of FEV1 during pulmonary exacerbation, and follow-up length (<2 yr, 2-5 yr, entire duration). Results: Rate of FEV1 decline estimates (percent predicted per year) differed between linear marginal and mixed-effects models; overall cohort estimates (95% confidence interval) were 1.26 (1.24-1.29) and 1.40 (1.38-1.42), respectively. Marginal models consistently estimated less rapid lung function decline than mixed-effects models across scenarios, except for short-term follow-up (both were ∼1.4). Rate of decline estimates from nonlinear models diverged by age 30. Among mixed-effects models, nonlinear and stochastic terms fit best, except for short-term follow-up (<2 yr). Overall CFFPR analysis from a joint longitudinal-survival model implied that an increase in rate of decline of 1% predicted per year in FEV1 was associated with a 1.52-fold (52%) increase in the hazard of death/lung transplant, but the results exhibited immortal cohort bias. Conclusions: Differences were as high as 0.5% predicted per year between rate of decline estimates, but we found estimates were robust to lung function data availability scenarios, except short-term follow-up and older age ranges. Inconsistencies among previous study results may be attributable to inherent differences in study design, inclusion criteria, or covariate adjustment. Results-based decision points reported herein will support researchers in selecting a strategy to model lung function decline most reflective of nuanced, study-specific goals.

A Joint Model for Unbalanced Nested Repeated Measures with Informative Drop-Out Applied to Ambulatory Blood Pressure Monitoring Data.

This study proposes a Bayesian joint model with extended random effects structure that incorporates nested repeated measures and provides simultaneous inference on treatment effects over time and drop-out patterns. The proposed model includes flexible splines to characterize the circadian variation inherent in blood pressure sequences, and we assess the effectiveness of an intervention to resolve pediatric obstructive sleep apnea. We demonstrate that the proposed model and its conventional two-stage counterpart provide similar estimates of nighttime blood pressure but estimates on the mean evolution of daytime blood pressure are discrepant. Our simulation studies tailored to the motivating data suggest reasonable estimation and coverage probabilities for both fixed and random effects. Computational challenges of model implementation are discussed.

Correlation Between Different Parameters of Acute Myocardial Infarction and Obesity.

OBJECTIVE: To study if obesity had a detrimental effect on troponin after acute coronary syndrome. We investigated the effects of the body mass index (BMI) in post-myocardial infarction (MI) patients, and see the difference in troponin levels and other parameters between normal and overweight patients. METHODOLOGY: A retrospective cohort study was conducted. Data were extracted from the electronic medical files of patients hospitalized due to acute ST-elevation MI to examine the association between BMI and MI. Sixty-one patients were categorized into normal BMI category, overweight, and obese/morbid obesity groups using the baseline measurements, to assess the independent factors associated with a patient with a high BMI who had a MI. RESULTS: In total, 61 post-myocardial infarction patients with a mean age of 56.9 ± 11.2 years were included in the study. The average BMI was 28.5 ± 6.5 kg/m2. Just more than a third (37.4%, n=23) were in the normal BMI category, 19 (31.2%) overweight, and 19 (31.2%) obese/morbid obesity. The mean left ventricle mass was 93.74 ± 32.69 gram and the mean left ventricular ejection fraction was 44.02% ± 10.02. A significant difference in the mean level of troponin and mean heart rate between the body mass index groups (normal vs. overweight groups) was noted. A fair correlation was noted between BMI and left ventricle mass. No statistically significant relation could be linked to high BMI with total cholesterol, low-density lipoprotein (LDL), or aspartate transferase/alanine transaminase (AST/ALT) levels. CONCLUSIONS: In this pilot study, the group with a high BMI had a statistically significant lower troponin level and higher mean heart rate. Such data need to be considered when assessing a patient's risk. In addition, obese persons with a MI had a higher left ventricle mass.

Maintaining Hepatitis B Protection in Immunocompromised Pediatric Rheumatology and Inflammatory Bowel Disease Patients.

OBJECTIVE: Hepatitis B virus (HBV) infection remains a significant public health challenge, particularly for immunocompromised patients. Our aim was to evaluate the serologic immunity in immunocompromised rheumatology and inflammatory bowel disease (IBD) patients, assess factors for serologic nonimmunity, and evaluate their response to 1 HBV booster dose. METHODS: Immunocompromised rheumatology and IBD patients with completed HBV screening were identified. A chart review was performed to collect demographics, clinical information, baseline HBV serology results, and serologic response to booster vaccination. Serologic nonimmunity was defined as a negative/indeterminate hepatitis B surface antibody (anti-HBs) level. RESULTS: Among 580 patients, 71% were nonimmune. The highest portion of nonimmune patients were 11-18 years old (P = 0.004). There was no significant difference between immune and nonimmune patients with regards to diagnosis (P = 0.34), age at diagnosis (P = 0.64), duration of treatment (P = 0.07), or type of medications (P = 0.08). Sixty-two percent of those who received a booster vaccine were rescreened, and most (68%) seroconverted. In those 18 years or older, only half seroconverted. CONCLUSION: Results of this study support the benefit of HBV screening in immunosuppressed patients. Beginning at age 11 years, most patients lacked serologic immunity to HBV. Seroconversion for most patients 11-18 years occurred after 1 booster vaccine. Thus, for immunocompromised patients without recent HBV serologic data, obtaining the HBV serology beginning at age 11 years might be considered. Those 18 years and older were least likely to seroconvert after 1 booster, indicating that they may benefit from receiving the 3-dose HBV vaccine series.

Survival and Prognosis for Malignant Tumors of Odontogenic Origin.

OBJECTIVE: Determine survival and factors affecting survival for patients with malignant tumors of odontogenic origin. STUDY DESIGN: Retrospective analysis of the National Cancer Institute's SEER database (Surveillance, Epidemiology, and End Results). SETTING: Tertiary medical center. SUBJECTS AND METHODS: All cases of malignant tumors of odontogenic origin were extracted from the SEER database for the period of 1973 to 2011. Demographic, tumor-specific, and survival data were tabulated and Kaplan-Meier survival analysis conducted according to histopathologic results. Cox regression analysis stratified for histopathology was conducted to determine factors that influenced survival. RESULTS: A total of 308 cases of malignant tumors with odontogenic origin were analyzed. Malignant ameloblastoma accounted for 59.7% of cases, followed by malignant odontogenic tumor (35.4%; including odontogenic carcinoma, odontogenic sarcoma, primary intraosseous carcinoma, and ameloblastic carcinoma) and ameloblastic fibrosarcoma (2.9%). The overall mean and median were 229 and 227 months, respectively, while the 5-year survival rate was 81% for the entire cohort. Malignant ameloblastoma exhibited the best mean survival (237 months), whereas malignant odontogenic tumor (139 months) and ameloblastic fibrosarcoma (42 months) had lower mean survival rates. Younger age, surgery with adjuvant radiation, and smaller tumor size were found to improve survival. CONCLUSIONS: Significantly different survival can be expected depending on individual tumor histopathology, tumor size, age at diagnosis, and treatment modality.