Changes in Cerebral Regional Oxygen Saturation Variability in Neonates Undergoing Cardiac Surgery: A Prospective Cohort Study.

Near-infrared spectroscopy is routinely used in the monitoring of cerebral regional oxygen saturation (crSO2) in neonates following congenital heart surgery. Decreased postoperative crSO2 variability in these patients is associated with worse clinical outcomes, including neurodevelopmental outcomes. We sought to explore changes in crSO2 variability between the preoperative and postoperative periods and associations with short-term clinical outcomes in neonates undergoing cardiac surgery. We performed a prospective cohort study of neonates undergoing cardiac surgery with cardiopulmonary bypass between November 2019 and May 2021. We calculated crSO2 variability using averaged 1 min of crSO2 values for a minimum of 12 h before, and the first 48 h following surgery. 37 neonates (median age at start of monitoring 4 days (interquartile range 2-5 days)) were included in our study. We observed a 30% decrease in crSO2 variability between the preoperative and postoperative monitoring periods (p < 0.001). Preoperative crSO2 variability increased by 9% (p = 0.009) for each additional postnatal day. There were no associations between the degree of decrease in crSO2 variability postoperatively and class of cardiac lesion (e.g., aortic arch obstruction, single ventricle physiology) or short-term postoperative clinical outcomes. There was a significant decrease in postoperative crSO2 variability following neonatal cardiac surgery as compared to the preoperative period, likely influenced by several factors. The impact of interventions on crSO2 variability and resultant influence on long-term outcomes, such as neurodevelopmental outcomes, requires further exploration.

CASE FATALITY RATE OF CHILDHOOD TUBERCULOSIS: EXPERIENCE FROM FEDERAL TEACHING HOSPITAL GOMBE: A TWO DECADE REVIEW.

Introduction: Tuberculosis (TB) was the leading cause of death from an infectious agent worldwide, until the Coronavirus (COVID-19) pandemic, ranking above HIV/AIDS. Nigeria ranks 6th among the 30 TB high-burden countries (TB, TB/HIV, DRTB) and 1st in Africa. The estimated case fatality rate (CFR) of TB in Sub-Sahara Africa (SSA) is 15%. Objective: To review the Tuberculosis case fatality rate (TCFR) in children diagnosed with TB from 2000-2019 in Federal Teaching Hospital Gombe. Methodology: All cases of Tuberculosis (TB) diagnosed in children using ICD 10 classification were retrieved and analyzed. These included deaths from TB. The mainstay of TB diagnosis was clinical using TB Score (81%), Gene Xpert was 7%, and AFB was 10%. Results: 26,716 children were admitted; 383 had TB out of which 208(54.3%) were males and 175 (45.7%) females. TB constituted 1.4% of Paediatric admissions. Children 0 -5 years constituted 46.7% (179/383) of cases and 11 - 18 years were 31.3% (120/383). Fulani, Hausa, and Tangale constituted 43.6% (167), 21.1% (81), and 6.8% (26) of TB cases respectively. TB admissions were highest between 2015 and 2019 (31.8%). TB adenitis was the most common extrapulmonary TB. Tuberculosis/HIV co-infection accounted for 103(27%), out of which 74% (44) died. Overall TCFR was 15.6%; TCFR was 16.3% in males and 14.8% in females. The TCFR was 46.7% in 0-5yrs; 15% in 6-9yrs and 38.3% in 10-18yrs.Fulani had the highest CFR (11.9%). Tuberculosis CFR was highest between 2010-2014 (30.0%) and lowest in 2005-2009 (21.6%). Conclusion: The Tuberculosis CFR is comparable to SSA CFR.

Multiscale MD simulations of wild-type and sickle hemoglobin aggregation.

Sickle cell disease is a hemoglobinopathy resulting from a point mutation from glutamate to valine at position six of the ß-globin chains of hemoglobin. This mutation gives rise to pathological aggregation of the sickle hemoglobin and, as a result, impaired oxygen binding, misshapen and short-lived erythrocytes, and anemia. We aim to understand the structural effects caused by the single Glu6Val mutation leading to protein aggregation. To this end, we perform multiscale molecular dynamics simulations employing atomistic and coarse-grained models of both wild-type and sickle hemoglobin. We analyze the dynamics of hemoglobin monomers and dimers, study the aggregation of wild-type and sickle hemoglobin into decamers, and analyze the protein-protein interactions in the resulting aggregates. We find that the aggregation of sickle hemoglobin is driven by both hydrophobic and electrostatic protein-protein interactions involving the mutation site and surrounding residues, leading to an extended interaction area and thus stable aggregates. The wild-type protein can also self-assemble, which, however, results from isolated interprotein salt bridges that do not yield stable aggregates. This knowledge can be exploited for the development of sickle hemoglobin-aggregation inhibitors.

Primary cutaneous mucormycosis in a premature neonate treated conservatively with amphotericin B.

Cutaneous mucormycosis is a rare, often fatal fungal infection that most commonly affects patients with underlying immunosuppression but also can occur in premature neonates. We report the case of an extremely premature boy (<25 weeks) who developed primary cutaneous mucormycosis shortly after birth. Although surgical debridement has been a mainstay of treatment in combination with antifungal therapy, our patient was successfully treated with amphotericin B alone-the management only reported in three other cases to date. We present this case to highlight that prompt initiation of treatment with amphotericin B alone may be an appropriate alternative to surgical intervention, particularly in patients with non-angioinvasive disease who are poor surgical candidates.

Framework for Considering Abnormal Heart Rate Characteristics and Other Signs of Sepsis in Very Low Birth Weight Infants.

OBJECTIVE: A heart rate characteristics index (HeRO score), incorporating low variability and superimposed decelerations, was developed as a sepsis risk indicator for preterm infants in the neonatal intensive care unit (NICU). A rise in the risk score should prompt consideration of other clinical changes that may be signs of sepsis to decide whether a workup and antibiotics are needed. We aimed to develop a framework to systematically consider signs potentially indicating sepsis in very low birth weight (VLBW) infants. STUDY DESIGN: We developed easy-recall acronyms for 10 signs of sepsis in VLBW infants. Over 12 months in a level IV NICU, neonatology fellows completed a brief survey after each shift to document changes prompting sepsis workups. We analyzed associations between survey data, hourly heart rate characteristic data, and the diagnosis of the workup, grouped as culture-positive sepsis (CXSEP, positive blood or urine culture), clinical sepsis (CLINSEP, negative cultures treated with antibiotics ≥5 days), or sepsis ruled out (SRO, negative cultures and <3 days antibiotics). RESULTS: We analyzed 93 sepsis workups in 48 VLBW infants (35 CXSEP, 20 CLINSEP, and 38 SRO). The most frequently cited changes prompting the workups were heart rate patterns and respiratory deterioration, which were common in all three categories. Low blood pressure and poor perfusion were uncommonly cited but were more likely to be associated with CXSEP than the other signs. A rise in the HeRO score ≥1 from 0 to 12 hours before compared with 12to 72 hours prior the blood culture occurred in 31% of workups diagnosed as CXSEP, 16% CLINSEP, and 31% SRO. CONCLUSION: The HeRO score can alert clinicians to VLBW infants at high or increasing risk of a sepsis-like illness, but heart rate characteristic patterns are highly variable in individual babies. The easy-recall NeoSEP-10 framework can assist clinicians in considering other clinical changes when making decisions about sepsis workups and the duration of antibiotics. KEY POINTS: · Abnormal heart rate characteristics can indicate sepsis or other pathologies in preterm infants.. · We developed a simple bedside tool to consider clinical signs potentially associated with sepsis.. · Considering vital sign trends together with clinical changes is a key to right-timing antibiotics..

Rational Drug Design of Peptide-Based Therapies for Sickle Cell Disease.

Sickle cell disease (SCD) is a group of inherited disorders affecting red blood cells, which is caused by a single mutation that results in substitution of the amino acid valine for glutamic acid in the sixth position of the ß-globin chain of hemoglobin. These mutant hemoglobin molecules, called hemoglobin S, can polymerize upon deoxygenation, causing erythrocytes to adopt a sickled form and to suffer hemolysis and vaso-occlusion. Until recently, only two drug therapies for SCD, which do not even fully address the manifestations of SCD, were approved by the United States (US) Food and Drug Administration. A third treatment was newly approved, while a monoclonal antibody preventing vaso-occlusive crises is also now available. The complex nature of SCD manifestations provides multiple critical points where drug discovery efforts can be and have been directed. These notwithstanding, the need for new therapeutic approaches remains high and one of the recent efforts includes developments aimed at inhibiting the polymerization of hemoglobin S. This review focuses on anti-sickling approaches using peptide-based inhibitors, ranging from individual amino acid dipeptides investigated 30-40 years ago up to more promising 12- and 15-mers under consideration in recent years.

Carbonic anhydrase inhibitors in patients with respiratory failure and metabolic alkalosis: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Metabolic alkalosis is common in patients with respiratory failure and may delay weaning in mechanically ventilated patients. Carbonic anhydrase inhibitors block renal bicarbonate reabsorption, and thus reverse metabolic alkalosis. The objective of this systematic review is to assess the benefits and harms of carbonic anhydrase inhibitor therapy in patients with respiratory failure and metabolic alkalosis. METHODS: We searched the following electronic sources from inception to August 2017: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and SCOPUS. Randomized clinical trials were included if they assessed at least one of the following outcomes: mortality, duration of hospital stay, duration of mechanical ventilation, adverse events, and blood gas parameters. Teams of two review authors worked in an independent and duplicate manner to select eligible trials, extract data, and assess risk of bias of the included trials. We used meta-analysis to synthesize statistical data and then assessed the certainty of evidence using the GRADE methodology. RESULTS: Six eligible studies were identified with a total of 564 participants. The synthesized data did not exclude a reduction or an increase in mortality (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.57 to 1.56) or in duration of hospital stay (mean difference (MD) 0.42 days, 95% CI -4.82 to 5.66) with the use of carbonic anhydrase inhibitors. Carbonic anhydrase inhibitor therapy resulted in a decrease in the duration of mechanical ventilation of 27 h (95% CI -50 to -4). Also, it resulted in an increase in PaO2 (MD 11.37 mmHg, 95% CI 4.18 to 18.56) and a decrease in PaCO2 (MD -4.98 mmHg, 95% CI -9.66, -0.3), serum bicarbonate (MD -5.03 meq/L, 95% CI -6.52 to -3.54), and pH (MD -0.04, 95% CI -0.07 to -0.01). There was an increased risk of adverse events in the carbonic anhydrase inhibitor group (RR 1.71, 95% CI 0.98 to 2.99). Certainty of evidence was judged to be low for most outcomes. CONCLUSION: In patients with respiratory failure and metabolic alkalosis, carbonic anhydrase inhibitor therapy may have favorable effects on blood gas parameters. In mechanically ventilated patients, carbonic anhydrase inhibitor therapy may decrease the duration of mechanical ventilation. A major limitation of this finding was that only two trials assessed this clinically important outcome.

Chromosome-level assembly of the gray fox (Urocyon cinereoargenteus) confirms the basal loss of PRDM9 in Canidae.

Reference genome assemblies have been created from multiple lineages within the Canidae family; however, despite its phylogenetic relevance as a basal genus within the clade, there is currently no reference genome for the gray fox (Urocyon cinereoargenteus). Here, we present a chromosome-level assembly for the gray fox (U. cinereoargenteus), which represents the most contiguous, non-domestic canid reference genome available to date, with 90% of the genome contained in just 34 scaffolds and a contig N50 and scaffold N50 of 59.4 and 72.9 Megabases, respectively. Repeat analyses identified an increased number of simple repeats relative to other canids. Based on mitochondrial DNA, our Vermont sample clusters with other gray fox samples from the northeastern United States and contains slightly lower levels of heterozygosity than gray foxes on the west coast of California. This new assembly lays the groundwork for future studies to describe past and present population dynamics, including the delineation of evolutionarily significant units of management relevance. Importantly, the phylogenetic position of Urocyon allows us to verify the loss of PRDM9 functionality in the basal canid lineage, confirming that pseudogenization occurred at least 10 million years ago.

Medical Students' Competency and Confidence in Interpreting Electrocardiograms at King Faisal University, Al-Ahsa.

Introduction Electrocardiography is a crucial emergency tool in the pre-hospital situation. It is a useful non-invasive diagnostic technique for quickly identifying various heart disorders. The clinical value of the electrocardiogram (ECG) depends on the clinician's ability to interpret the result of the ECG accurately. Aims This study aims to assess the competency as well as the confidence in the interpretation of ECG among medical students at King Faisal University, Al Ahsa, Saudi Arabia. Methods This cross-sectional study was conducted among medical students enrolled at King Faisal University. Four hundred and ten (410) medical students from all five years completed an electronic self-administered pre-validated questionnaire. The questionnaire includes basic demographic data and ECG strips to assess medical students' competency and confidence levels in interpreting each case. Results More than half of the medical students were considered to have low competency (56.1%) and confidence (59%) levels. Increased competency and confidence scores were associated with fifth-year medical students and those who learned more about ECG interpretation through teaching during clinical rotations. The majority of medical students correctly interpreted anterior MI (69.3%), ventricular tachycardia (65.6%), and supraventricular tachycardia (61.2%). On the other hand, most students were unable to correctly identify pacemaker ECG (19.8%), long QT (21.2%) and left bundle branch block (33.4%). Conclusion Medical students' competency and confidence in ECG interpretation seems to be lacking. Fifth-year medical students who learned more ECG skills through teaching during clinical rotations tended to be more competent and confident with their ECG interpretation skills.

Assessing the Correlation Between Patient-Specific Characteristics and Braden Pressure Injury Risk Score at a Suburban Tertiary Hospital in Nigeria.

Background and objective Pressure injury (PI) is a frequent complication of hospital admissions, and it increases healthcare costs, morbidity, and mortality. This study aimed to use the Braden scale to assess the PI risk among hospitalized patients without PI and determine its association with patient-specific factors. Methods A cross-sectional study was conducted at a suburban tertiary hospital involving a total of 211 hospitalized patients recruited during the study period (October 2022). Patients were assessed using the Braden scale and their sociodemographic data were also recorded. Data analysis was performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY). Results The mean age of the patients was 41.8 ±23.0 years and 54.0% of the patients were females. The average Braden score of the patients was 19.01 ±3.42, and more than half (58.3%) of the patients showed no risk while only 0.9% of the patients had a severe risk of PI. There was a statistically significant association between PI risk and patients' age (r=-0.353, R=12.5%, p<0.001), pre-admission occupation (F=10.290, p<0.001) as well as the ward of admission (F=11.915, p<0.001). However, gender and social support were not significantly associated. Conclusion The age, pre-admission occupation, and ward of admission of patients were found to be significantly associated with the risk of developing PI. It is recommended that more resources be channeled toward preventing PI among high-risk patients in resource-limited settings.

Factors Associated with Anxiety During COVID-19 Pandemic and Its Association with Hypertension in Saudi Arabia.

Objective: Patients with chronic diseases such as hypertension (HTN) are considered a vulnerable group, and they are prone to anxiety and other psychological conditions during pandemics. Very few reports discussed factors related to anxiety and how it is associated with HTN during COVID-19 pandemic. In this project, we aimed to identify the prevalence of anxiety among hypertensive patients in Saudi Arabia during the COVID-19 pandemic. Methods: A cross-sectional study was conducted, and data were collected using an electronic self-administered pretested questionnaire distributed via trained data collectors. Data were analyzed using t-test and chi-test. Results: A total of 2135 participants were enrolled in this study. Anxiety was reported in 5% of all participants and 8% of the hypertensive participants. Older age, marital status, higher body mass index (BMI), smoking, and Khat chewing were strongly associated with anxiety among the general population. In addition, less adherence to medication made participants with HTN significantly more anxious. Conclusion: The prevalence of anxiety among hypertensive individuals is higher compared to the general population. Moreover, anxiety is significantly associated with some sociodemographic in the general population, and with less adherence to medications in hypertensive patients. Further studies with data from medical record including more variables are needed to highlight this association.

Knowledge and Awareness of Leukemia Among the Population of Eastern Province, Saudi Arabia.

INTRODUCTION: Cancer is characterized by the rapid proliferation of abnormal cells that exceed their normal boundaries, infiltrating other body parts and leading to metastasis, a distinctive feature setting it apart from other diseases. Metastasis is the primary cause of cancer-related deaths, with nearly 10 million global fatalities, making it the leading cause of mortality. Leukemia, a type of cancer originating in the bone marrow or blood cells, presents significant complications and is associated with various risk factors, including a positive family history, smoking, and obesity. This study aims to evaluate the general knowledge of leukemia and its associated risks among the inhabitants of the Eastern Province, Saudi Arabia. METHODS: A cross-sectional survey was conducted targeting all residents of the Eastern Province, Saudi Arabia, who were Saudi nationals, spanning both genders and aged 15 to 59 years. The questionnaire was distributed electronically through social networking applications, and responses were collected via Google Forms (Google, Mountain View, CA). RESULTS: The study findings indicated that the most frequently identified risk factors for leukemia included blood disorders, genetic disorders, and extensive exposure to radiation and chemicals. The most prevalent leukemia symptoms were bruising and bleeding, followed by vomiting, nausea, and headache. The most commonly reported side effects of leukemia treatment were dizziness, followed by anorexia and exhaustion. CONCLUSION: The study revealed a lack of awareness about leukemia and its associated risks among participants. This underscores the need for continued educational initiatives and awareness campaigns to improve leukemia knowledge and early detection rates, potentially leading to better outcomes for affected individuals. Future research should aim to overcome study limitations and provide a broader perspective on leukemia awareness throughout Saudi Arabia.

Utilization of Over-the-Counter Painkillers Among Medical Students During Academic Examinations.

The utilization of over-the-counter (OTC) painkillers among medical students during academic exams has raised concerns about health risks and potential implications, including substance abuse and academic performance. This cross-sectional study aimed to estimate the prevalence of OTC painkiller utilization among medical students at Alfaisal University during academic exams. Additionally, the study explored and identified the factors that influenced the patterns of OTC painkiller utilization among these students. The study was conducted from January to May 2023, following approval from the Institutional Review Board. The research involved surveying medical students of different genders, nationalities, and academic years during examination periods. Out of 1,500 medical students, 194 participated, resulting in a response rate of approximately 13%. The study results revealed that 50.5% of medical students used OTC painkillers during exams. While there were no significant variations based on gender or nationality, the prevalence of OTC painkiller utilization varied significantly across academic years. During exam periods, the primary reason reported for using OTC painkillers was pain management. Additionally, some students mentioned using OTC painkillers to seek relaxation, improve sleep, enhance concentration, and stay alert. These insights shed light on the coping strategies practiced by students during high-stress academic periods. Most participants demonstrated familiarity with the guidelines for safe OTC painkiller utilization. Although the majority used painkillers infrequently or as needed, a subgroup reported increased utilization during exams. This finding highlights the importance of continuous monitoring and health education initiatives to prevent or address potential OTC painkiller abuse among medical students during exam periods. Ensuring the well-being of medical students is a priority, and appropriate measures should be employed to address any emerging concerns related to substance abuse. By addressing these issues proactively, educational institutions can promote a healthier academic environment during exam periods.

Cancer Stigma Among 800 Saudi Citizens: A Cross-Sectional Study and Literature Review.

INTRODUCTION: Cancer-related stigmatization is a noteworthy phenomenon, yet it has not received sufficient attention in public health studies. Despite recent advancements in treatment and improvements in survival, the burden of stigma remains a challenging concern for individuals diagnosed with cancer. AIM: This study aims to assess the presence of cancer stigma in the Saudi Arabian population by using the Cancer Stigma Scale (CASS). METHODS: A cross-sectional study was conducted among the general population of Saudi Arabia. Data collection was facilitated through a self-administered online questionnaire, incorporating socio-demographic variables such as age, gender, and regional residence and employing the CASS instrument to gauge the prevalent attitudes and stigmas related to cancer. RESULTS: Out of the 874 participants, a majority of 87.1% were female, with 60.2% aged between 20 and 39 years. Notably, 59% reported having a close friend or family member diagnosed with cancer. The average CASS score stood at 1.59 (SD 0.39) on a 5-point scale, with an overwhelming 97.1% registering scores under 2.5, suggesting a generally low stigma perception. In dissecting the CASS components, 'severity' recorded the highest mean score (mean: 2.23), followed by 'awkwardness' (mean: 1.86) and 'financial discrimination' (mean: 1.71). 'avoidance' registered the lowest mean score at 1.11. Notably, a trend of increasing stigma was observed with advancing age, and male respondents indicated a marginally higher propensity towards stigmatizing attitudes. CONCLUSION: In Saudi Arabia, cancer-related stigma is generally low. However, 'severity' is the most prominent stigma aspect, with 'avoidance' being the least. Older individuals and males exhibit slightly higher stigmatizing attitudes. These insights highlight the need for targeted public health efforts to address remaining stigmatization, especially based on age and gender.

Awareness of the Link Between the Consumption of Ultra-Processed Food and Colorectal Cancer Risk in Saudi Arabia.

Introduction Cancer is a group of diseases with uncontrollable growth of abnormal cells. Colorectal cancer (CRC) is one of the most common cancers. Increased intake of animal-source foods, sedentary lifestyle, decreased physical activity, and increased prevalence of excess body weight are independently associated with CRC risk. Additional risk factors include heavy alcohol consumption, cigarette smoking, and consumption of red or processed meat. Ultra-processed food (UPF) is made utilizing multiple components and a number of procedures. Soft drinks and salty or sugary snacks typically contain a lot of added sugar, fats, and processed carbohydrates, which negatively affect the balance of the gut bacteria, nutrients, and bioactive substances that are necessary for the prevention of CRC. The aim of this study is to assess the awareness of the general population in Saudi Arabia toward the relationship between UPF and CRC. Methods A cross-sectional questionnaire-based study was conducted in Saudi Arabia between June and December, 2022. Result The study involved 802 participants, of which 84% consumed UPF and 71% were aware of the link between UPF and CRC. Only 18.3% were familiar with the particular type of UPF and only 29.4% knew how to prepare them. The prevalence of participants who were aware of the link between UPF and CRC was significantly more among the older age groups, people living in the Eastern Region, and those who knew how to manufacture UPF, while the prevalence of awareness was significantly less among those who regularly consumed UPF. Conclusion The study showed that a significant portion of subjects regularly ate UPF, and only a few were aware of its link to CRC. This highlights the need for greater awareness of the fundamentals of UPF and its impact on health. Governmental organizations should develop a strategy to raise public awareness of excessive UPF use.

Awareness of Blindness Related to Smoking Among Young Age Population: A Cross-Sectional Study in Saudi Arabia.

Globally, it is known that smoking can cause a variety of diseases. Studies have shown that smoking not only causes heart and lung diseases but is also strongly related to ocular diseases which could lead to blindness. This study aims to assess the level of awareness of blindness related to smoking in young people in Saudi Arabia. This is a descriptive cross-sectional study conducted among the young population in Saudi Arabia. A self-administered questionnaire was distributed using an online platform that includes socio-demographic data, education level, smoking status, and knowledge of the harmful effect of smoking like lung and cardiac diseases, including blindness. The data were analyzed using Statistical Packages for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). A total of 655 young individuals responded to the survey. Among our subjects, the prevalence of smoking participants was (18.7%) more common among the age group 21-25 years, males, bachelor, or higher degrees and those living in the Central region (p<0.001). Participants were definitely or probably more aware that the most common condition associated with excessive smoking was lung cancer (99.5%), followed by heart disease (98.1%) and stroke (93%) while the least of them was melanoma (91.3%) and blindness (81%). This is the first study in Saudi Arabia to assess the level of awareness of the risks of blindness related to smoking in young people and disclosed limited knowledge of the effect of smoking on their vision. The effects of smoking on lung cancer, heart disease, stroke, and even melanoma received higher ratings than blindness. Smokers may be able to quit smoking and enhance their quality of life by better understanding the link between smoking and blindness, which suggests that appropriate action is required to enhance their awareness.

Treatment of Depression With Alcohol and Substance Dependence: A Systematic Review.

Although alcohol and/or substance use disorders have been significantly associated with depression, data on the treatment outcomes of depression in this patient population are still scarce, especially among the higher risk of resistance to treatment. This study examines the management outcomes of depression in patients with alcohol and substance dependence during the last decade by searching the medical literature. The literature was searched through Medline, PsycInfo, Embase, and Ovid database from 2010 to 2020. Searching terms included were a combination of ''treatment'' AND ''Depression'' AND ''alcohol'' OR "substance abuse". A total of 617 articles were retrieved. After this, original articles investigating depression treatment outcomes in patients with alcohol or substance use disorders or both were selected. Following the exclusion of review studies and including only original research studies, 23 articles appeared. We selected eight articles as eligible, covering a total of 132,373 patients with depression and either alcohol dependence or substance use disorder. Anti-depressants (mainly selective serotonin reuptake inhibitors) combined with psychotherapy and alcohol or substance abuse treatment represent the best treatment modality for depression in this clinical setting. In conclusion, patients with alcohol or substance dependence usually suffer from treatment-resistant depression. However, the treatment of depressive symptoms would help in substance or alcohol abstinence and reduce recurrent substance abuse.

A systematic review of contemporary evidence on SARS-CoV-2 and HIV coinfection: What does it look like up to date?

BACKGROUND: Preexisting alteration of the immune system by factors including older age, cardiovascular diseases, morbid obesity, diabetes, and chronic obstructive pulmonary disease (COPD) have detrimental effects on SARS-CoV-2 patients. Literature regarding SARS-CoV-2/human immunodeficiency virus (HIV) is still developing. MATERIALS AND METHODS: We reviewed the existing literature pertaining to SARS-CoV-2/HIV coinfection systematically. Research records' characteristics and patients' clinical data were collected. RESULTS: Seven research records were included, of which three were case series and four were case reports, reporting a total of 16 cases. There was one case of death, whereas (15/16) patients were discharged home. Majority of patients developed consistent clinical presentation of SARS-CoV-2. All patients had initial positive RT-PCR results, and four cases had HIV-related lymphopenia. CONCLUSION: Although the current literature is still growing to increase our understanding of SARS-CoV-2/HIV coinfection, people living with HIV should adhere to the guidelines of healthy behavior and practice during this pandemic.

Knowledge of first aid skills among medical and nonmedical students in Saudi Arabia.

BACKGROUND: First aid is the first treatment a health care worker provides at the site of an accident to a patient who is injured or very sick before the ambulance arrives. First aid providers are those who have the skill and knowledge to deal with life-threatening conditions outside the facilitated environment of a hospital. This study aims to assess the knowledge of first aid among university students in Saudi Arabia. METHODOLOGY: An observational descriptive cross-sectional study was conducted from 17 August 2018 until 2 February 2019 on Saudi universities' students, including medical and nonmedical students and excluding postgraduate. The sample size was 384 students using a cluster sampling technique. The questionnaire was developed specifically for the purpose of this study after searching the literature and consulting an epidemiologist. It contains questions that assess the level of knowledge regarding first aid. It was subjected to a prop to test for validity and liability. Data were analyzed using (SPSS, version 22.0) and (P values of ≤ 0.05) considered significant. The consent was obtained before data collection. RESULT: Only 40.35% (157/389) of the total participants had basic life support (BLS) course in their college syllabus. Good knowledge was generally observed in both medical (61.2%) and nonmedical (53.2%) student participants. Medical students' knowledge regarding first aid was better than nonmedical students in all questions, whereas the results were not statistically significant. CONCLUSION: Medical students were more familiar with the knowledge of first aid than other colleges' students. Researches should investigate the willingness of medical students to apply their first aid knowledge when necessary using a health belief model.