Quality and Readability Assessment of Web-based Arabic Health Information on Early Childhood Caries.

Background: Patients are increasingly using the internet for searching health-related information. However, the quality and readability of the information available on the internet need to be assessed. To date, no study has assessed the quality and readability of web-based Arabic health information on early childhood caries. Objectives: To evaluate the quality and readability of patient-oriented online Arabic health information regarding early childhood caries. Materials and Methods: For this infodemiological study, the Google and Yahoo search engines were searched using specific Arabic terms for early childhood caries, and the top 100 searches from both search engines were considered. Eligible websites were categorized in terms of affiliation as commercial, health portal, dental practice, professional, and journalism. The quality of the websites was assessed using the QUality Evaluation Scoring Tool (QUEST), and readability using the Gunning Fog index (GFI). Results: A total of 140 websites were included after applying the exclusion criteria, of which 50.7% websites were of journalism. The majority of the websites (70%) had an overall low-quality level, with a QUEST score <10. The quality of websites retrieved from Google searches was of significantly higher quality than those from Yahoo (P < 0.0001). More than half (51.4%) of the websites had good readability, with a GFI score ≤8. Journalism websites had a significantly higher proportion of websites with poor readability level (62%) compared with other affiliations (P = 0.0072). Conclusion: The web-based Arabic information regarding early childhood caries is currently of low quality and moderate readability level, thereby indicating a need for improving such patient-facing content.

Visual Functions, Seatbelt Usage, Speed, and Alcohol Consumption Standards for Driving and Their Impact on Road Traffic Accidents.

Purpose:  The incidence of road traffic accidents (RTAs) is dramatically increasing worldwide. Consequently, driving and licensing authorities have instituted strict rules and regulations, such as vision standards, restrictions on drunk driving, seat belt usage, and speeding, for driving safety. This study aimed to summarize the global visual standards for driving license issuing and renewal and investigate the effect of driving safety laws on RTA-related death rates in different countries. Methods:  The study gathered data on visual standards for driving licenses from reliable sources and extracted enforcement scores (drunk driving, seat belt usage, and speeding) and RTA-related death rates from the World Health Organization status report on road safety. The Wilcoxon test explored the association between visual standards and RTA-related death rates, while the Kruskal-Wallis test analyzed the relationship between visual functions and death rates, as well as driving safety enforcement scores and RTA-related death rates. Results:  The analysis was conducted on 71 countries and 50 states within the United States out of the 193 countries listed by the United Nations. It was found that 116 countries and states required a minimum VA range of 6/6-6/18, while 91 countries and states mandated a similar range for one-eyed drivers. VF testing for driving licenses was necessary in 77 countries and states. No significant association was observed between VA or VF testing and RTA-related death rates. However, countries that conducted more visual function tests demonstrated lower rates of RTA-related fatalities. Furthermore, RTA-related death rates were significantly associated with speeding, drunk driving, and seat belt laws. Conclusion: Implementing clear policies regarding vision requirements, maintaining strict rules, and promoting law enforcement on speeding, drunk driving, and seat belt usage are crucial for improving road safety. These measures should be prioritized by driving and licensing authorities worldwide to mitigate the escalating incidence of RTAs.

Prevalence, Microbiological Profile, and Risk Factors of Surgical Site Infections in Saudi Patients with Colorectal Cancer.

Background: Resection surgery in patients with colorectal cancer (CRC) patients is associated with potential complications, including surgical site infection (SSI). Objectives: To estimate the prevalence rate of SSI, identify the common pathogens responsible for SSI, and determine potential risk factors for SSI development in a cohort from Saudi Arabia. Materials and Methods: Patients with CRC who underwent bowel resection surgery at King Abdulaziz Medical City, Riyadh, between January 01, 2016, and December 31, 2019, were retrospectively included. Demographics, comorbidities, surgical procedure data, and the results of preoperative laboratory tests were retrospectively collected from medical records through the health information system. The study population was divided into two groups: those who developed SSI and those who did not. Results: A total of 92 patients with CRC who underwent resection surgery were included, of which 54 (58.7%) were males. The median age was 65 (IQR 55.5-75.0) years. SSI was observed in 25 (27.2%) patients. The most frequently isolated organisms were Escherichia coli and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae, vancomycin-sensitive Enterococcus faecium, and methicillin-resistant Staphylococcus aureus. Three E. coli isolates were producers of extended-spectrum beta-lactamases, and two K. pneumoniae isolates exhibited a multidrug resistance profile. Low preoperative serum albumin level was identified as a significant independent risk factor for developing SSI (AOR = 0.853, 95% CI = 0.748-0.973, P = 0.0181). Conclusion: The study found a notable prevalence of SSI among the included patients. Gram-negative bacteria were more involved in SSI events and were also associated with drug-resistance patterns. Gut microbiota bacteria were most commonly involved in SSIs. Low preoperative serum albumin levels predicted the development of postoperative SSI, and thus its close monitoring and management before surgery could reduce the SSIs.

Outcomes of Pediatric Traumatic Cardiac Arrest: A 15-year Retrospective Study in a Tertiary Center in Saudi Arabia.

BACKGROUND/OBJECTIVE: Traumatic cardiac arrest (TCA) is the cessation of cardiac pumping activity secondary to blunt or penetrating trauma. The aim of this study is to identify the outcomes of traumatic cardiac arrest in pediatric patients within the local community and report the causes and resuscitation management for the defined cases. METHODS: This was a retrospectively conducted cohort study that took place in King Abdulaziz Medical City (KAMC) and King Abdullah Specialized Children Hospital (KASCH) from 2005 to 2021, Riyadh, Kingdom of Saudi Arabia. The study population involved pediatric patients aged 14 years or less who were admitted to our Emergency Department (ED) and had a traumatic cardiac arrest in the ED. RESULTS: There were 26,510 trauma patients, and only 56 were eligible for inclusion. More than half (60.71%, n= 34) of the patients were males. Patients aged four years or less constituted 51.79% (n= 29) of the included cases. The majority of patients were Saudis (89.29%, n= 50). The majority of the patients had cardiac arrest prior to ED admission (78.57%, n= 44). The majority (89.29%, n= 50) had a GCS of 3 at ED arrival. The most frequently observed first cardiac arrest rhythm was asystole, followed by pulseless electrical activity and ventricular fibrillation, accounting for 74.55%, 23.64%, and 1.82%, respectively. CONCLUSION: Pediatric TCA is high acuity. Children who experience TCA have dreadful outcomes, and survivors can suffer serious neurological impairments. We provided the experience of one of the largest trauma centers in Saudi Arabia to standardize the approach for managing TCA and, hopefully, improve its outcomes.

The Impact of COVID-19 Infection on Patients with Chronic Diseases Admitted to ICU: a Cohort Retrospective Study.

The coronavirus disease (COVID-19) infection is causing significant morbidity and mortality rates worldwide. A comprehensive investigation of the disease characteristics, especially among vulnerable disease groups, could help better manage the disease and reduce the pathogen's effect. This retrospective study examined the impact of COVID-19 infection on three groups of patients with chronic diseases. We investigated the clinical characteristics and outcomes of 535 COVID-19 patients with cardiovascular diseases (CVD), chronic kidney diseases (CKD), and Cancer that were admitted to the Intensive Care Unit (ICU). Of the total cases, 433 patients (80.93%) were discharged from the ICU, and 102 patients (19.06%) were declared dead. Patients' symptoms, their clinical laboratory findings, number and type of medications, length of ICU stay, and outcome were collected and analyzed. Most COVID-19 patients included in our study were associated with other comorbidities such as diabetes mellitus, hypertension, and heart disease and failure. Upon ICU admission, the main COVID-19-related symptoms in CVD, CKD, and cancer patients were cough (55.73, 50.42, and 50.5%, respectively), Shortness of Breath (SOB) (59.38, 43.1, and 43.7%, respectively), and fever (41.15%, 48.75%, and 28.2%, respectively). In terms of lab findings, D-dimer, LDH, and inflammatory markers, in particular, were outside the normal range. Treatment options for patients with COVID-19 in ICU were mainly antibiotics, synthetic glucocorticoids, and Low Molecular Weight Heparin (LMWH). Furthermore, CKD patients had a longer ICU stay (13.93 ± 15.87 days) which illustrates the poorer outcome in this group of patients compared with the others. In conclusion, our results highlighted the significant risk factors among COVID-19 patients within the three groups. This can guide physicians in prioritizing ICU admission and help in the management of critically ill patients with COVID-19.

The impact of the COVID-19 pandemic on rehabilitation services provided for cochlear implant recipients in Saudi Arabia.

OBJECTIVE: This study examines the impact of the COVID-19 pandemic on cochlear implantation (CI) recipients in Saudi Arabia. The impact was measured using the results of an online survey that investigated challenges related to access to re/habilitation and programming services, increased dependence on virtual interaction, and emotional impact. METHODS: The cross-sectional online survey reached 353 pediatric and adult CI recipients between April 21st and May 3rd 2020, during the first weeks of implementing the lockdown strategy and the transitioning to virtual settings. RESULTS: It was revealed that overall access to aural re/habilitation was considerably affected during the pandemic, and that the impact of this disruption was significantly greater for pediatric recipients than for adults. On the other hand, overall access to programming services was not affected. Results also revealed that CI recipients' performance at school or work was negatively impacted by the transition to a virtual communication. In addition, participants noticed a decline in their auditory performance, language skills, and speech understanding. They also registered feelings of anxiety, social isolation, and fear related to sudden changes in their CI function. Finally, the study revealed a gap between CI clinical/non-clinical support provided during the pandemic and the expectations of CI recipients. CONCLUSION: Collectively, outcomes from this study highlight the importance of shifting towards a more patient -centered model that offers empowerment and self-advocacy. In addition, the outcomes also emphasize the importance of developing and adapting emergency protocols. This will ensure continuation of services provided to CI recipients during scenario disasters like a pandemic.Key messagesPediatric aural re/habilitation was subjected to a significantly greater interruption, compared to adult aural re/habilitation, duringthe COVID-19 shutdown.Cochlear Implant (CI) recipients expressed feelings of anxiety, social isolation, and fear. These feelings were related to sudden changes in their CI functioning, caused by interruption of support services during the pandemic.Patient -centered model can offer emergency protocols that ensure a smooth continuation of cochlear implant-related re/habilitation and services during disaster scenarios such as the COVID-19 pandemic.

Antimicrobial prophylaxis and the rate of blood stream infections and Clostridioides difficile in pediatric stem cell transplantation: A single-center retrospective study.

BACKGROUND: The use of prophylactic antibiotics in the pre-engraftment period to minimize the risk of bacteremia is debatable given concerns of Clostridioides difficile (C. diff), antibiotics resistance, and disruption of gut microbiota. METHODS: We retrospectively reviewed the rate and characteristics of bacteremia and C. diff infections within the first 100 days post-HSCT in all pediatric patients who received routine antibacterial prophylaxis during HSCT from 2015 to 2018. C. diff infection was defined by the presence of three or more unformed stools in 24 h and positive stool test for C. diff or its toxins. RESULTS: One hundred and thirty-five (100 allogeneic and 35 autologous) transplants in 123 patients were eligible for analysis. Median age at transplant was 7.1 (range 0.2-13.7), 67 (55%) were women, and diagnosis was malignant condition in 68 patients. Median time to neutrophil engraftment was 18 days (13-23). Cefepime or piperacillin-tazobactam prophylaxis was used in 105 (78%) and 28 (21%) of patients, respectively. Only five (3%) patients had bacteremia during the pre-engraftment period, and 13 (11%) patients developed bacteremia postengraftment. Septic shock was present in only one patient pre-engraftment and was due to gram-negative bacteria. All patients who developed bacteremia received MAC. Thirteen patients (10%) of patients fulfilled C. diff infection definition. There was no mortality related to bacterial infections among our patients. CONCLUSIONS: The use of antibiotic prophylaxis was associated with low rate of bacteremia in the pre-engraftment period and a 10% risk of C. diff infections. More studies are needed to better evaluate the efficacy of antibiotic prophylaxis in HSCT patients.

Coinfection of pulmonary tuberculosis with other lower respiratory tract infections: A retrospective cross-sectional study.

BACKGROUND: Little attention has been given to the development of lower respiratory tract infections (LRTIs) in patients with pulmonary tuberculosis (PTB) during their anti-tuberculosis (anti-TB) treatment and how that might affect patients' health status. Here, the prevalence and etiologies of other LRTIs in a cohort of PTB patients were determined, and the clinical features and outcomes were described. METHODS: Adult patients with PTB between 2015 and 2020 were recruited and monitored during their anti-TB treatment for the presence of LRTIs. Clinical data were retrospectively collected from patients' medical records. RESULTS: Data from 76 PTB patients (57 [75%] males) were reviewed. The median age was 61.0 (interquartile range 83.5-35.5) years, and other LRTIs were detected in 45 (59.2%) PTB patients. Of the 126 episodes of LRTIs, 84 (66.7%) were due to bacterial infections, 37 (29.4%) were due to fungal infections, and 5 (3.9%) were due to viral infections. The development of LRTIs was significantly more common in older (P = 0.012) and hypertensive patients with PTB (P = 0.019). Patients with PTB and LRTIs experienced significantly more frequent extrapulmonary infections (P = 0.0004), bloodstream infections (P = 0.001), intensive care unit stays (P = 0.001), and invasive mechanical ventilation use (P = 0.03) than patients who did not develop LRTI. CONCLUSIONS: The identification of host-related risk factors for LRTI development among patients with PTB could be used to develop a prediction model for LRTI development. Hence, initiating antimicrobials early, in parallel with appropriate anti-TB treatment, may mitigate PTB-related health and economic consequences.

Clinical characteristics and outcomes of ischemic stroke patients during Ramadan vs. non-Ramadan months: Is there a difference?

Objectives: To study the clinical characteristics and outcomes of patients experiencing an ischemic stroke during Ramadan vs. non-Ramadan months in a tertiary academic center in an Islamic country. Methods: We retrospectively reviewed all patients with ischemic stroke (IS) in Ramadan and non-Ramadan months for four consecutive years (February 2016-June 2019). All demographics, vascular risk factors, laboratory results, modified Rankin Scale (mRS) at admission and discharge, National Institute Stroke Scale (NIHSS), and in-hospital complication data were collected for all patients. Results: One thousand and 58 patients were included (non-Ramadan, n = 960; during Ramadan, n = 98). The mean age during Ramadan was 59 ± 13 years. Most non-Ramadan IS patients during Ramadan were male (68.5%; 57.1%, respectively). There was no statistical difference in vascular risk factors and medical history between the two groups. However, Ramadan patients had higher median NIHSS scores at discharge (p = 0.0045). In addition, more ICU admissions were noted among Ramadan patients (p = 0.009). In the gender-specific analysis for Ramadan patients, we found a statistically significant difference in smoking and urinary tract infection (p = 0.006, p = 0.005, respectively). Conclusion: Based on our results, there was no difference, in general, between patients with IS during Ramadan and non-Ramadan months. However, IS patients had higher NIHSS scores at discharge and more ICU admissions during Ramadan. Last, we suggest future studies with larger sample sizes, longer duration, and including all types of strokes.

Long-term peripheral retinal vascular behavior in retinopathy of prematurity patients treated with ranibizumab intravitreal injection as monotherapy using fluorescein angiography.

BACKGROUND: Few challenges are faced with the introduction of anti-VEGF agents as a modality of treatment for retinopathy of prematurity. The clinical behavior and time course of regression post injection differ compared to post laser ablation. This study aims to evaluate the long-term peripheral retinal vascularization outcome of Ranibizumab intravitreal injections monotherapy in the treatment of retinopathy of prematurity. METHOD: Hospital-based quasi-experimental study. Include ROP patients who received intravitreal ranibizumab (IVR), as primary treatment for type 1 ROP. Patients were examined under general anaesthesia to ensure documentation of all junctions of vascular and avascular zones. Images were taken by RetCam III, Phoenix ICON and fluorescein angiography was performed to describe vascular behaviors. RESULTS: The mean gestational age was 24.67 weeks and the mean postmenstrual age at the time of intravitreal ranibizumab treatment was 36.3 weeks. Fluorescein angiography was performed at 155-288 weeks; most eyes showed two disk diameters of avascular peripheral retina. Only eyes with original aggressive ROP who required a second injection (six eyes) showed extensive peripheral avascular retina reaching zone I (13.64%). Neovascularization was evident in five eyes (11.36%), all with an original aggressive ROP and received multiple injections. CONCLUSIONS: Ranibizumab treated babies with incomplete retinal vascularization require close and long-term follow-up visits to assess post injection vascular behavior. Peripheral retinal avascular zone of more than two-disc diameters was present in most of the patients evidenced by fluorescein angiography. Babies with initial diagnosis of aggressive ROP are more likely to have persistent peripheral neovascularization.

Comparison of Hospital Readmission and Mortality between COVID-19 and Pneumonia Patients.

Coronavirus disease 2019 (COVID-19) survivors can have lasting signs and symptoms, including various organ damage, indicating that COVID-19 can be a chronic illness. The current study aims to compare the 30-day hospital readmission and death rate of patients admitted to the hospital with COVID-19 and pneumonia due to other causes. A retrospective cohort study was conducted using data from the Saudi National Guard Health Affairs (NGHA). Records of patients admitted with COVID-19 between 1 March 202 and 31 December 2020 (n = 3597) and pneumonia during 2017 and 2019 (n = 6324) were retrieved and analyzed. We compared the likelihood of 30-day hospital readmission, intensive care unit (ICU) admission, and death between the two groups. Compared with the control group, COVID-19 patients had higher odds of 30-day readmission (odds ratio 1.90, 95% confidence interval 1.61-2.24), higher risk of ICU transfer (hazard ratio 1.85, 95% confidence interval 1.65-2.07), more extended hospital stay (7 vs. 4 days), but less risk of death (hazard ratio 0.18, 95% confidence interval 0.14-0.24). The findings that hospital readmission was higher in COVID-19 recovered patients than in other pneumonia patients inform the current discussion about readmission and death in COVID-19 patients.

Characteristics of Hospitalized Adults With Recurrent Urinary Tract Infection Due to Extended Spectrum Beta-Lactamase Producing Escherichia coli in a Tertiary Center in Saudi Arabia.

BACKGROUND: The increase in extended-spectrum ß-lactamase (ESBL) producing microbes in recent years represents a major challenge. AIM: To study the risk factors for urinary tract infections (UTIs) caused by ESBL-producing Escherichia coli in patients requiring hospitalization for treatment. MATERIALS AND METHOD: Electronic health records were used to identify 616 inpatients over the age of 18 who had UTI symptoms and/or signs and an ESBL-producing E. coli strain cultured on urine culture between January 1 and December 31, 2018. The electronic health care records of these patients were searched to identify those patients with previous UTIs due to an ESBL-producing E. coli grown on urine culture. Patients with cancer or those taking prophylactic antibiotics or immunosuppression were excluded. RESULT: Risk factors for the acquisition of ESBL-producing E. coli included male sex (P = 0.0032), age over 66 years (P < 0.0001), renal stones (P = 0.0021), urology intervention within six months of presentation (P = 0.0360), pressure sores (P = 0.0002), feeding tubes (P = 0.0076), and urinary catheter (P = 0.0023). Comorbidities (e.g., diabetes mellitus and duration of antibiotic therapy were not associated with an increased risk of recurrence of ESBL-producing E. coli UTI (P = 0.4680, P = 0.3826, respectively). CONCLUSION: Antimicrobial stewardship programs may have reduced the development of antimicrobial resistance in E. coli. However, the recognition of risk factors for UTI caused by ESBL-producing E. coli may facilitate the early detection of high-risk cases and guide treatment decisions. This can improve patient outcomes while decreasing the length of the hospital stay.

Long-term effectiveness of carglumic acid in patients with propionic acidemia (PA) and methylmalonic acidemia (MMA): a randomized clinical trial.

BACKGROUND: Propionic acidemia (PA) and methylmalonic acidemia (MMA) are rare, autosomal recessive inborn errors of metabolism that require life-long medical treatment. The trial aimed to evaluate the effectiveness of the administration of carglumic acid with the standard treatment compared to the standard treatment alone in the management of these organic acidemias. METHODS: The study was a prospective, multicenter, randomized, parallel-group, open-label, controlled clinical trial. Patients aged ≤ 15 years with confirmed PA and MMA were included in the study. Patients were followed up for two years. The primary outcome was the number of emergency room (ER) admissions because of hyperammonemia. Secondary outcomes included plasma ammonia levels over time, time to the first episode of hyperammonemia, biomarkers, and differences in the duration of hospital stay. RESULTS: Thirty-eight patients were included in the study. On the primary efficacy endpoint, a mean of 6.31 ER admissions was observed for the carglumic acid arm, compared with 12.76 for standard treatment, with a significant difference between the groups (p = 0.0095). Of the secondary outcomes, the only significant differences were in glycine and free carnitine levels. CONCLUSION: Using carglumic acid in addition to standard treatment over the long term significantly reduces the number of ER admissions because of hyperammonemia in patients with PA and MMA.

Diabetic Ketoacidosis Treatment Outcome and Associated Factors Among Adult Patients Admitted to the Emergency Department and Medical Wards at King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background Diabetic ketoacidosis (DKA) is a life-threatening condition with high morbidity and mortality rates. It should be diagnosed immediately and managed intensively to prevent its significant complications. Objectives The aim of this study to assess DKA treatment outcome and associated factors among adult patients at King Abdulaziz Medical City Emergency Department and Medical Wards, Riyadh, Saudi Arabia. Materials and Methods A retrospective cross-sectional study was conducted using a chart review to assess DKA treatment outcome and associated factors. All patients who were admitted as DKA cases from September 2017 to August 2019 were selected by simple random sampling except those with incomplete charts or younger than 14 years. Data were entered and analyzed using SAS Version 9.4 (SAS Institute, Cary, NC, USA). Results A total of 223 reviewed charts were collected. The frequency of DKA recurrence in most of the patients was once per year (126 [56.5%]). The most common precipitating factor was inappropriate insulin therapy (104 [46.64%]). More than half of the patients (120 [53.81%]) got out of DKA management protocol within 24-72 hours with a hospital stay of less than or equal to five days. The mortality rate was 1.83%. Patients with two or more DKA episodes per year tended to be admitted to ICU more frequently than those with one episode (p=0.001). It was found that patients who had a duration of one to five years of diabetes mellitus were almost five times more likely to get out of DKA in more than 72 hours when compared with those who had a duration of more than five years (adjusted OR: 4.7; 95% CI: 1.34-16.60; p=0.01). Conclusions The findings of this study highlight that majority of DKA patients showed improvement and discharged with a very low mortality rate. Inappropriate insulin therapy was the most common precipitating factor; thus, educating diabetic patients about the complications of treatment non-compliance is an important part of management.