Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention 2024 updated consensus on the prevention of respiratory syncytial virus.

Respiratory syncytial virus (RSV) is the major cause of bronchiolitis among children under 5 years of age worldwide, accounting for a prevalence of 25%-88% in Saudi Arabia. Although no effective treatment for the virus exists, passive immunoprophylaxis reduced RSV hospitalizations in high-risk children. With recent advances in immunization, the Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention panel screened recent relevant international guidelines, locally published data, and expert consensus to update guidelines for RSV prevention, taking into consideration the resources, timing, varying health profiles, and RSV burden in Saudi Arabia. The panel updated its recommendations to include immunization of infants, mothers, and older adults. Practical guidelines were prepared to facilitate the administration of the short-acting and newly developed long-acting RSV monoclonal antibodies (mAb) during the regular follow-ups of high-risk infants in specialized clinics. In addition, long-acting mAb was highlighted as all-infant protection in the routine immunization calendar.

Respiratory Syncytial Virus (RSV) Burden in Infants in the Kingdom of Saudi Arabia and the Impact of All-Infant RSV Protection: A Modeling Study.

INTRODUCTION: Respiratory syncytial virus (RSV) represents a considerable burden on the healthcare system and hospital resources. This study explored the impact of universal immunoprophylaxis with long-acting monoclonal antibody (nirsevimab) during infants' first RSV season on RSV-induced health events and related costs in the Kingdom of Saudi Arabia (KSA). METHODS: The burden of RSV-induced health events and related costs under the current standard of practice (SoP) and the impact of universal immunoprophylaxis with nirsevimab was estimated using a static decision-analytic model in a cohort of infants experiencing their first RSV season in the KSA. The model estimated hospital admissions (including pediatric intensive care unit [PICU] admissions and mechanical ventilation [MV]), emergency room (ER) visits, primary care (PC) visits, long-term sequelae, and RSV mortality. RESULTS: The model estimated that under the current SoP, RSV results in 17,179-19,607 hospitalizations (including 2932-3625 PICU and 172-525 MV admissions), 57,654-191,115 ER visits, 219,053-219,970 PC visits, 14 deaths, 12,884-14,705 cases of recurrent wheezing, and a total cost of SAR 480-619 million. Universal nirsevimab immunoprophylaxis was estimated to avert 58% of hospitalizations (58% PICU admissions, 58% MV episodes), 53% of ER visits, 53% of PC visits, 58% of episodes of recurrent wheezing, 8 deaths, and result in savings of SAR 274-343 million in total healthcare cost. CONCLUSION: Compared with current SoP, an nirsevimab immunoprophylaxis strategy in the KSA for all infants during their first RSV season was estimated to dramatically decrease healthcare resource use, and economic burden associated with RSV.

Prevalence and Risk Factors of Asthma in Children and Adolescents in Rabigh, Western Saudi Arabia.

The worldwide prevalence of asthma in children is variable. The different epidemiological definitions of asthma, the use of various methods of measurement, and the environmental variations between countries are responsible for such different prevalence rates. This study has been performed to identify the prevalence/risk factors of asthma in Saudi children/adolescents in Rabigh. A cross-sectional epidemiological survey has been conducted using the validated Arabic version of the "International Study of Asthma and Allergies in Childhood questionnaire". Data on the sociodemographic characteristics of participants and risk factors of asthma have also been collected. Three hundred and forty-nine Children/adolescents with an age range of 5-18 years have been randomly selected for an interview from public places and houses in different regions of Rabigh City. The prevalence rates of physician-diagnosed asthma, any wheezing, and wheezing in the last 12 months among children/adolescents (mean age: 12.22 ± 4.14 years) have remarkably increased in association with the rapidly developing industrialization of Rabigh from previously recorded rates of 4.9%, 7.4%, and 6.4% in the only study that has previously been conducted in Rabigh in 1998 to 31.5%, 23.5%, and 14.9%, respectively. The univariate analysis has detected some significant risk factors for asthma. However, in younger aged children (5-9 years), allergic rhinitis, associated chronic illnesses, and viral respiratory infection-induced wheezing have remained significant risk factors of any wheezing. Drug allergy, exposure to dust, and viral respiratory infection-induced wheezing have persisted as significant risk factors for wheezing in the last 12 months. Eczema in the family, exposure to perfumes/incense, and viral respiratory infection-induced wheezing have remained as significant risk factors of physician-diagnosed asthma. The results of this survey should be useful in future targeted preventive plans/measures with special attention to improving air quality to limit the progressive increase in asthma prevalence in Rabigh, as well as in other similar industrial communities.

Evaluation of the virtual learning environment by school students and their parents in Saudi Arabia during the COVID-19 pandemic after school closure.

BACKGROUND: Very few previous studies have involved school students or their parents in the evaluation of virtual learning environment (VLE). Thus, this survey was performed to evaluate the satisfaction of both school students and their parents with the VLE in the Kingdom of Saudi Arabia during the COVID-19 pandemic. METHODS: A cross-sectional questionnaire-based survey was distributed online for VLE evaluation. The questionnaire was based on previous studies and expert opinions from validated instruments for assessing distance education, integrative and literature reviews of VLE environment. A median value >3 indicated participant satisfaction in each of the 5 domains of the questionnaire as well as overall VLE satisfaction. The used questionnaire was checked after its implementation by all possible statistical means and it was found to be of acceptable validity and reliability. RESULTS: Six hundred and ninety-three participants including 571 Saudi citizens and 122 non-Saudi residents participated in this survey. The number of school students who agreed or strongly agreed were significantly lower than the number of students who disagreed or strongly disagreed with preferring the VLE over traditional education (p<0.001). The participants evaluated the VLE experience as unsatisfactory with a median value ≤3 for 4 out of 5 questionnaire domains with an overall satisfaction value of 2.8. Among the 117 participants who gave further written opinions/comments, 42(35.9%) participants supported the VLE as an alternative to traditional classrooms, if equipment and internet are made available and for the safety of their children. CONCLUSIONS: This is one of few available adequate population-based studies for exploring the VLE satisfaction of both Saudi citizens and non-Saudi residents school students and their parents. This study showed the participants' unsatisfactory VLE experience. The VLE is accepted as an alternative to traditional classrooms to keep up with learning and to maintain the safety of children and it can be a supplementary learning method but many measures are still needed to develop the VLE.

Adverse Drug Reactions (ADRs) of Montelukast in Children.

Montelukast is a leukotriene receptor antagonist (LTRA) commonly prescribed for asthma, allergic rhinitis and sleep-related breathing disorders. Recently, some studies have reported several adverse events, such as neuropsychiatric disorders and sleep disturbances, among children. OBJECTIVE: To obtain more insight into the safety profile of montelukast for children with asthma, allergic rhinitis and sleep-related breathing disorders. METHOD AND RESULTS: We retrospectively studied all adverse drug reactions to montelukast among 385 children 6 months or older in six tertiary centers over a two-year period. A total of 89.6% were asthmatic, 50% had allergic rhinitis and 13.6% had sleep-related breathing disorders; Singulair was the most common type of montelukast used (67.9%). This study reported a high prevalence of adverse drug reactions among 123 patients (31.9%), predominantly in those aged 4-9 years (52.8%), followed by adolescents (24.4%) and toddlers (22.8%). Two (ADRs) were reported in 9.8% of the children, while three or more were reported in 5.5%. Sleep disturbance was the most common (ADRs), affecting 15.1% of participants (overlap was common; 5.5% of children experienced sleep difficulties, 4.4% experienced sleep interruption and decreased sleep, and 1.82% experienced nightmares), followed by agitation (10.4%), pain (9.4%) and hyperactivity (6.8%). No serious (ADRs) were reported. Eleven percent of families faced difficulties in purchasing montelukast, and only 57% of families had insurance. Misconceptions were common (9.8% reported it to be a steroid, while 30.6% believed it to be a bronchodilator). Although 81% of the families believed it was an effective and preventive medication, 5.3% stopped the drug due to concern about side effects, especially agitation (3%) and nightmares (0.6%). CONCLUSION: These data demonstrate that montelukast is effective, but the associated adverse neuropsychiatric drug reactions are more prevalent than those reported in the literature. In particular, sleep disturbance, agitation, pain and hyperactivity were observed. Pediatricians should be aware of such (ADRs). Misconceptions about montelukast are still common, and parental counseling and urgent epidemiological studies are needed to quantify the risk for management plans.

Pediatricians' knowledge and attitude toward hearing loss and newborn hearing screening programs.

INTRODUCTION: Early detection of hearing loss is important to the management of infants and young children with hearing loss. Pediatricians are often the first to encounter a child suspected to have hearing loss. The objective of this study is to evaluate the knowledge and attitude of newborn hearing screening and management of hearing in among pediatricians. METHODS: A cross-sectional survey-based study utilizing a validated questionnaire that was distributed to pediatricians in single tertiary academic health care institution that aims to evaluate the knowledge and attitudes related to children with hearing loss and newborn hearing screening. RESULTS: A total of 67 pediatricians agreed to participate and were involved in our study. Mean age was 35 years and 44.1% were males. The majority (79.4%) thought it was very important to have a newborn hearing screening program. However, two-thirds (64.7%) were unsure that there is a universal hearing screening program in the country. Never the less, the majority of the respondents (75%) were at least somewhat confident in explaining the hearing screening program process in our institution. There was a gap in the knowledge of our pediatricians with regard to the process of dealing with a newborn who failed screening program and the candidacy for cochlear implants. Also, some participants were unsure whether to refer a child with hearing impairment to an otolaryngologist or not. Most of the participants thought that physicians need more information related to permanent hearing loss. CONCLUSION: There are gaps in Pediatricians knowledge and awareness towards hearing loss assessment and management in newborns. This likely requires further academic collaboration between specialties to improve the care of newborns. Future research should focus on the auditory and speech outcome and rehabilitation awareness.

Severe asthma in children: An official statement from Saudi Pediatric Pulmonology Association.

In Saudi Arabia, the prevalence of pediatric asthma ranges between 8% and 25%. However, there are no sufficient data regarding severe asthma in childhood in Saudi Arabia. Therefore, a task force has been formed by the Saudi Pediatric Pulmonology Association which is a subsidiary group of the Saudi Thoracic Society and consists of Saudi experts with well-respected academic and clinical backgrounds in the fields of pediatric asthma as well as other respiratory diseases to write a consensus on definitions, phenotypes, and pathophysiology, evaluation, and management. To achieve this, the subject was divided into various sections, each of which was assigned to at least 2 experts. Without a central literature review, the authors searched the literature using their own strategies. To reach an agreement, the entire panel reviewed and voted on proposed findings and recommendations.

Novel MYO1D Missense Variant Identified Through Whole Exome Sequencing and Computational Biology Analysis Expands the Spectrum of Causal Genes of Laterality Defects.

Laterality defects (LDs) or asymmetrically positioned organs are a group of rare developmental disorders caused by environmental and/or genetic factors. However, the exact molecular pathophysiology of LD is not yet fully characterised. In this context, studying Arab population presents an ideal opportunity to discover the novel molecular basis of diseases owing to the high rate of consanguinity and genetic disorders. Therefore, in the present study, we studied the molecular basis of LD in Arab patients, using next-generation sequencing method. We discovered an extremely rare novel missense variant in MYO1D gene (Pro765Ser) presenting with visceral heterotaxy and left isomerism with polysplenia syndrome. The proband in this index family has inherited this homozygous variant from her heterozygous parents following the autosomal recessive pattern. This is the first report to show MYO1D genetic variant causing left-right axis defects in humans, besides previous known evidence from zebrafish, frog and Drosophila models. Moreover, our multilevel bioinformatics-based structural (protein variant structural modelling, divergence, and stability) analysis has suggested that Ser765 causes minor structural drifts and stability changes, potentially affecting the biophysical and functional properties of MYO1D protein like calmodulin binding and microfilament motor activities. Functional bioinformatics analysis has shown that MYO1D is ubiquitously expressed across several human tissues and is reported to induce severe phenotypes in knockout mouse models. In conclusion, our findings show the expanded genetic spectrum of LD, which could potentially pave way for the novel drug target identification and development of personalised medicine for high-risk families.

COVID-19 related posttraumatic stress disorder in children and adolescents in Saudi Arabia.

INTRODUCTION: The COVID-19 pandemic resulted in quarantine/lockdown measures in most countries. Quarantine may create intense psychological problems including post-traumatic stress disorder (PTSD) especially for the vulnerable critically developing children/adolescents. Few studies evaluated PTSD associated with infectious disasters but no Saudi study investigated PTSD associated with COVID-19 in children/adolescents. This study was undertaken to screen for PTSD in children/adolescent in Saudi Arabia to identify its prevalence/risk factors during COVID-19 pandemic and its quarantine. METHODS: A cross-sectional survey was conducted after 2 months form start of quarantine for COVID-19 pandemic utilizing the original English version and an Arabic translated version for the University of California at Los Angeles Brief COVID-19 Screen for Child/Adolescent PTSD that can be parent-reported or self-completed by older children/adolescents. Participants (Saudi citizens/non-Saudi residents) were approached online via social media. RESULTS: Five hundred and thirty seven participants were enrolled. The participants were 262 boys and 275 girls with a mean age of 12.25±3.77 years. Symptoms of no, minimal, mild and potential PTSD were identified in 15.5%, 44.1%, 27.4% and 13.0% of children/adolescents, respectively. The age, gender, school grade, and residence were not predictive of PTSD symptoms. Univariate analysis of risk factors for PTSD revealed that work of a close relative around people who might be infected was significantly different between groups of PTSD symptoms, but this difference disappeared during multivariate analysis. Children/adolescents of Saudi citizens had significantly lower median total PTSD score than children/adolescents of expatriate families (p = 0.002). CONCLUSION: PTSD associated with the COVID-19 and its resultant quarantine shouldn't be overlooked in different populations as it is expected in a considerable proportion of children/adolescents with variable prevalence, risk factors and severity. Parents/healthcare providers must be aware of PTSD associated with COVID-19 or similar disasters, so, they can provide children/adolescent with effective coping mechanisms.

Acute kidney injury in children with COVID-19: a retrospective study.

BACKGROUND: Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission. METHODS: This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging. RESULTS: Of 89 children included, 19 (21 %) developed AKI (52.6 % stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15 % vs. 1.5 %). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32 % vs. 2.8 %, p < 0.001) and mortality (42 % vs. 0 %, p < 0.001). However, AKI was not associated with prolonged hospitalization (58 % vs. 40 %, p = 0.163) or development of MIS-C (10.5 % vs. 1.4 %, p = 0.051). No patient in the AKI group required renal replacement therapy. Residual renal impairment at discharge occurred in 9 % of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture. CONCLUSIONS: AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.

Clinical characteristics and outcomes of children with COVID-19 in Saudi Arabia.

OBJECTIVES: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection. METHODS: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. RESULTS: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14.5%). The most prominent presenting complaints were fever (80.6%) and cough (48.4%). Most of our patients (80.6%) had mild disease, 11.3% had moderate disease, and 8.1% exhibited severe and critical illness. Twenty-one patients (33.9%) were hospitalized, with 4 patients (6.5%) admitted to the pediatric intensive care unit, and 3 (4.8%) patients died. CONCLUSION: All pediatric age groups are susceptible to COVID-19, with no gender difference. COVID-19 infection may result in critical illness and even mortality in subsets of pediatric patients.

Coronavirus disease in children: A multicentre study from the Kingdom of Saudi Arabia.

BACKGROUND: The COVID-19 global pandemic caused by severe acute respiratory syndrome coronavirus 2 infection, warranted attention for whether it has unique manifestations in children. Children tend to develop less severe disease with a small percentage present with clinical manifestations of paediatric multisystem inflammatory syndrome and have poor prognosis. We studied the characteristics of COVID-19 in children requiring hospitalisation in the Kingdom of Saudi Arabia and assessed the clinical presentation and the risk factors for mortality, morbidity, and paediatric intensive care (PICU) admission. METHODS: We conducted a retrospective analysis of COVID-19 patients under 15 years hospitalised at three tertiary academic hospitals between 1 March and 30 June 2020. RESULTS: Eighty-eight children were enrolled (>20% were infants). Seven (8%) were in critical condition and required PICU admission, and 4 (4.5%) died of which 3 met the full diagnostic criteria of multi-system inflammatory syndrome and had a high Paediatric Risk of Mortality (PRISM) score at the time of admission. The initial polymerase chain reaction (PCR) test result was positive for COVID-19 in most patients (97.7%), and the remaining two patients had positive result in the repeated confirmatory test. In a subset of patients (20 subjects), repeated PCR testing was performed until conversion to negative result, and the average duration for conversion was 8 (95% CI: 5.2-10.5) days Children requiring PICU admission presented with signs of respiratory distress, dehydration, and heart failure. Most had fever (71.4%) and tonsillitis; 61.4% were discharged within 7 days of hospitalisation. Risk factors for mortality included skin rash, hypotension, hypoxia, signs of heart failure, chest radiograph suggestive of acute respiratory distress syndrome, anaemia, leucocytosis, hypernatraemia, abnormal liver enzymes, and high troponin I, and risk factors for prolonged hospitalisation (>7 days) included the presence of comorbidities, leucopaenia, hyponatraemia, and elevated C-reactive protein. CONCLUSIONS: The majority of hospitalised children had a brief febrile illness and made a full recovery, but a minority had severe disease.

Implementation of Safe Sleep Practice Recommendations for Infants in Inpatient Wards.

Background Sudden infant death syndrome (SIDS) is defined as the sudden unexpected death of an infant, even after conducting thorough investigations and autopsy. SIDS is related to several factors, such as baby's position and presence of pillows, blankets and objects in the crib. The implementation of safe sleep recommendations in the inpatient setting is unknown and there is a scarcity of available data. Methods This was an observational, cross-sectional study that was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All infants less than one year of age were considered after fulfilling the inclusion criteria. A checklist was developed in alignment with the latest American Association of Pediatrics (AAP) recommendations and an an independent observer was trained on how to evaluate and record the various components of the checklist. Results One hundred and two patients were enrolled in this study. The mean age of participants was 18.85 weeks. Asleep infants were found to be mostly placed in their cribs (71.4%), on their back (81%). Among the sleeping infants, 46% of them were swaddled at the time of data collection. Blankets were present in 79.4% of the cases, and loose sheets in more than half of the cases. Pillows were seen in 42.2% of the beds. No bumper pads were present in any of the beds. Conclusion This observational study highlights the importance of increasing awareness about safe sleep practices. Not only is it important for ensuring patient safety during admissions but also to send an important message to caregivers through role-modeling. Further studies are required to examine the barriers to implementing recommended safe sleep practices both within institutions that care for infants as well as among parents and caregivers.

Childhood Asthma Awareness in Saudi Arabia: Five-Year Follow-Up Study.

BACKGROUND: Bronchial asthma is a chronic inflammatory airway disease that is characterized by reversible airway obstruction due to bronchial hyperresponsiveness. It is one of the most common chronic diseases. In Saudi Arabia, asthma affects 2 million people with asthma frequency in children markedly higher than adults with regional variations ranging from 9% to 33.7%. OBJECTIVE: The aim of this study is to measure asthma awareness and knowledge of study participants during the ongoing annual Saudi asthma awareness campaigns and compare them with previous survey data conducted in 2014. METHODS: A cross-sectional study was carried out in the form of a survey distributed across three major cities in Saudi Arabia, Jeddah, Riyadh and Dammam, during the National Asthma Awareness Campaign in major regional shopping centers in April 2019. Asthma knowledge scores across different demographic groups were generated from surveyed data. Descriptive and correlative statistical analyses were performed to identify factors associated with changes in asthma knowledge. Scores were compared to previous survey results. RESULTS: The mean score for asthma knowledge was 15.6 out of 25. Asthma knowledge significantly correlated with age (P=0.002), asthma status of the participants (P=0.001), having children with asthma (P=0.005) or knowing friends or family with asthma (P=0.029) but not with other socioeconomic factors such as gender, marital status, occupation, level of education and number of children in the family (P > 0.05). There was a significant difference in the asthma scores from 2014 (M= 63%, SD=26) to 2019 (M= 70%, SD= 26) conditions; t (24) = -2.106, p=0.046. CONCLUSION: Further educational campaigns are necessary to enhance and measure general public awareness of asthma, its differential diagnosis against other respiratory infections, environmental triggers, risk factors as well as treatment options.

Exome sequencing and metabolomic analysis of a chronic kidney disease and hearing loss patient family revealed RMND1 mutation induced sphingolipid metabolism defects.

Mitochondrial disorders (MIDs) shows overlapping clinical presentations owing to the genetic and metabolic defects of mitochondria. However, specific relationship between inherited mutations in nuclear encoded mitochondrial proteins and their functional impacts in terms of metabolic defects in patients is not yet well explored. Therefore, using high throughput whole exome sequencing (WES), we screened a chronic kidney disease (CKD) and sensorineural hearing loss (SNHL) patient, and her family members to ascertain the mode of inheritance of the mutation, and healthy population controls to establish its rare frequency. The impact of mutation on biophysical characteristics of the protein was further studied by mapping it in 3D structure. Furthermore, LC-MS tandem mass spectrophotometry based untargeted metabolomic profiling was done to study the fluctuations in plasma metabolites relevant to disease causative mutations and kidney damage. We identified a very rare homozygous c.631G > A (p.Val211Met) pathogenic mutation in RMND1 gene in the proband, which is inherited in an autosomal recessive fashion. This gene is involved in the mitochondrial translational pathways and contribute in mitochondrial energy metabolism. The p.Val211Met mutation is found to disturb the structural orientation (RMSD is -2.95 Å) and stability (ΔΔG is -0.552 Kcal/mol) of the RMND1 protein. Plasma metabolomics analysis revealed the aberrant accumulation of metabolites connected to lipid and amino acid metabolism pathways. Of these metabolites, pathway networking has discovered ceramide, a metabolite of sphingolipids, which plays a role in different signaling cascades including mitochondrial membrane biosynthesis, is highly elevated in this patient. This study suggests that genetic defects in RMND1 gene alters the mitochondrial energy metabolism leading to the accumulation of ceramide, and subsequently promote dysregulated apoptosis and tissue necrosis in kidneys.

Risk Factors and Predictors of Severe Dengue in Saudi Population in Jeddah, Western Saudi Arabia: A Retrospective Study.

This study was performed to determine the risk factors and predictors of severe dengue fever (SDF) in Saudi population in Jeddah, Western Saudi Arabia. This 7-year retrospective study included children and adults with confirmed dengue from 2010 to 2016. Demographic, clinical, laboratory, serological, and virologic data were collected. Comparative analyses were performed between pediatric and adult SDF cases defined according to the WHO 2009 dengue classification. During the study period, dengue was confirmed in 17,646 cases with predominant infection of adults (6.5 times that of children) and males (3.8 times that of females). May and June were associated with 43.9% of total dengue cases. All 56 pediatric and 187 adult SDF cases were hospitalized. At least one warning sign of severe illness was present in 92.2% of total SDF cases. Mortality rates were 8.9% and 10.7% of pediatric and adult SDF cases, respectively. Multiple logistic regression detected that the most significant risk factors and predictors of SDF in adults versus children were significantly more secondary dengue infection (adjusted odds ratio [AOR]: 2.20, 95% CI: 1.09-4.44, P = 0.02), significantly less clinical fluid accumulation (AOR: 0.17, 95% CI: 0.07-0.44, P < 0.001) and significantly less neutropenia (AOR: 0.41, 95% CI: 0.17-0.97, P = 0.04). This was the first large multicenter study evaluating SDF in Saudi population and considering the WHO 2009 dengue classification, which showed predominant infection of adults and males with dengue, few SDF cases with low mortality and highlighted predictors of SDF in adults versus children. Consideration of warning signs for severe dengue may result in hospital admission, prompting closer monitoring, timely and proper interventions and reduced mortality in SDF cases.

Are Safe Sleep Practice Recommendations For Infants Being Applied Among Caregivers?

Background Sudden infant death syndrome (SIDS) is defined as the sudden unexpected death of an infant, even after investigations and autopsy. SIDS is related to many factors, such as the baby's position and objects in the crib. Adherence to safe sleep recommendations in Saudi Arabia is unclear. This study aims to assess caregivers' implementation of safe sleep practices and if they received any safe sleep education through health care workers. Methods This was a cross-sectional, descriptive study. Inclusion criteria included all infants below the age of one year. Exclusion criteria included infants who were born premature, used ventilation, had a tracheostomy, any anomaly in the upper airway, or underwent spine surgery. A semi-structured questionnaire was used. Data were collected from mothers who had infants visiting the outpatient department of King Abdulaziz University Hospital in Jeddah, Saudi Arabia. An electronic survey was also created and published on a social platform.  Statistical analysis was conducted with the aid of the Statistical Package for Social Sciences (SPSS) software, version 26 (IBM SPSS Statistics, Armonk, NY). Results Among 506 participants, only 22.5% were found to receive education about safe practices from health care providers. Fortunately, most of the infants (63.2%) were found to sleep in a supine position most of the nights. Adherent caregivers to placing the child in a designated baby bed and in a supine position most nights represented 44.86% of the sample. However, when asked about placing any of the following objects in the bed (pillows, blankets, soft toys, hard toys, and electric wires), the percentage of adherence dropped down to only 1.58%. Conclusion There was an obvious non-adherence among caregivers and a possible lack of knowledge of safe sleep recommendations for infants. This highlights the need for optimal education by health care workers and the rule of media and campaigns is obvious and essential to improving their practices and, hopefully, decreasing the risk of SIDS.

The prevalence of childhood asthma in Saudi Arabia.

Asthma is considered one of the most important health issues worldwide. However, few epidemiological studies have been conducted in Saudi Arabia to assess the prevalence of asthma among children, and their results are highly variable. Thus, in this study, we investigated the prevalence of childhood asthma in Saudi Arabia. Previous studies of the prevalence of childhood asthma in Saudi Arabia were reviewed and 12 were included in this review. These studies were conducted at various locations in Saudi Arabia between 1986 and 2017. The prevalence of children asthma in Saudi Arabia varies among different regions throughout the country. The highest prevalence was reported in Alhofuf (33.7%) and the lowest in Abha (9%). However, various surveying methods were used and different age groups were assessed. This review highlights the need to conduct a national-level study using a single validated tool to assess the prevalence of childhood asthma in Saudi Arabia in order to calculate the burden of asthma and determine the targeted allocation of resources and manpower.

Expression of Cell-Penetrating Peptides Fused to Protein Cargo.

Cell-penetrating peptides (CPPs) are short peptides that can cross cell membranes. CPPs enable the delivery of biomolecules into cells and can act as drug-delivery vectors. Because recombinant production of CPPs as fusions to protein "cargo" leads to low yields for some CPP-cargo fusions, approaches to enhance the recombinant expression of peptide-cargo fusions need to be identified. We optimized expression conditions in Escherichia coli for fusions of CPPs (SynB, histatin-5, and MPG) to the cargo proteins biotin carboxyl carrier protein, maltose-binding protein, and green fluorescent protein. We used Western blotting to evaluate induction temperatures of 37, 30, and 20°C, and induction times of 6, 10, and 24 h. Glutathione-S-transferase was incorporated as a fusion partner to improve expression. In general, expression at 37°C for 6 and 10 h led to the highest levels of expression for the different CPP-cargo constructs. The improvements in expression of CPP-cargo fusions will allow higher yields of CPP-cargo fusions for studies of their translocation into cells.

Chitosan microparticles based polyelectrolyte complex scaffolds for bone tissue engineering in vitro and effect of calcium phosphate.

Chitosan microparticles were mixed with chitosan and carboxymethyl cellulose solution to achieve a good binding between the microparticles. Three different compositions of scaffolds were made by varying the calcium phosphate (CaP) amount: 0%, 10%, and 20%. Potassium chloride was used as salt, to make pores inside the scaffolds after leaching out when immersed in phosphate buffer saline (PBS). Compressive strength and compressive modulus of both non-porous (before leaching out), and porous (after leaching out) scaffolds were measured according to the ASTM standards. The highest compressive strength of 27 MPa was reported on 10% CaP scaffolds while 20% CaP scaffolds showed the lowest. The increasing CaP content reduces the compressive strength of the scaffolds. The highest wet state compressive strength was reported on 0% CaP scaffolds with 0.36 MPs and 0.40 MPa at day 1 and day 3 respectively. In vitro cell culture studies showed good cell adhesion and cell proliferation on 10% CaP scaffolds.