Circulating tumor DNA (ctDNA) application in investigation of cancer: Bench to bedside.

Now, genomics forms the core of the precision medicine concept. Comprehensive investigations of tumor genomes have made it possible to characterize tumors at the molecular level and, specifically, to identify the fundamental processes that cause condition. A variety of kinds of tumors have seen better outcomes for patients as a result of the development of novel medicines to tackle these genetic-driving processes. Since therapy may exert selective pressure on cancers, non-invasive methods such as liquid biopsies can provide the opportunity for rich reservoirs of crucial and real-time genetic data. Liquid biopsies depend on the identification of circulating cells from tumors, circulating tumor DNA (ctDNA), RNA, proteins, lipids, and metabolites found in patient biofluids, as well as cell-free DNA (cfDNA), which exists in those with cancer. Although it is theoretically possible to examine biological fluids other than plasma, such as pleural fluid, urine, saliva, stool, cerebrospinal fluid, and ascites, we will limit our discussion to blood and solely cfDNA here for the sake of conciseness. Yet, the pace of wider clinical acceptance has been gradual, partly due to the increased difficulty of choosing the best analysis for the given clinical issue, interpreting the findings, and delaying proof of value from clinical trials. Our goal in this review is to discuss the current clinical value of ctDNA in cancers and how clinical oncology systems might incorporate procedures for ctDNA testing.

The utility of serum glucose potassium ratio as a predictive factor for haemorrhagic transformation, stroke recurrence, and mortality among ischemic stroke patients.

Background and Objective: Glucose-Potassium Ratio (GPR) has emerged as a biomarker in several pathophysiological conditions. However, the association between GPR and long-term outcomes in stroke patients has not been investigated. Our study evaluated the applicability of baseline GPR as a predictive prognostic tool for clinical outcomes in ischemic stroke patients. Methods: The multicenter retrospective cohort study included acute-subacute adult ischemic stroke patients who had their baseline serum GPR levels measured. Eligible patients were categorized into two sub-cohorts based on the baseline GPR levels (<1.67 vs. ≥ 1.67). The primary outcome was the incidence of 30-day hemorrhagic transformation, while stroke recurrence, and all-cause mortality within twelve months, were considered secondary. Results: Among 4083 patients screened, 1047 were included in the current study. In comparison with GPR < 1.67 group, patients with ≥ 1.67 GPR had a significantly higher ratio of all-cause mortality within twelve months (aHR 2.07 [95 % CI 1.21-3.75] p = 0.01), and higher ratio of 30-day hemorrhagic transformation but failed to reach the statistical significance (aHR 1.60 [95 % CI 0.95-2.79], p = 0.08). Conclusion: Overall, baseline GPR serum is an independent predictor of all-cause mortality within twelve months in patients with acute and subacute ischemic stroke. Further clinical studies are necessary to validate these findings.

Knowledge of and Testing Rate for Hepatitis C Infection among the General Public of Saudi Arabia: A Cross-Sectional Study.

INTRODUCTION: The Ministry of Health in Saudi Arabia has announced a plan to eradicate hepatitis C virus (HCV) infection. This study sought to evaluate the knowledge levels and testing rate among the general population of Saudi Arabia. METHODS: A cross-sectional study was conducted using data collected from an online, self-administered survey. Multivariable analysis was conducted using multiple binary logistic regression models to identify factors associated with low knowledge levels as well as predictors of HCV testing. RESULTS: A total of 689 participants completed the survey. While most participants (88%) have heard of HCV infection, less than half (47.3%) understood that HCV is curable with medications. More than half of the participants (53.7%) have low knowledge about HCV infection. Testing for HCV was reported by 123 respondents (17.8%), and the odds of testing for HCV were significantly lower among residents of the Makkah region (OR = 0.59 [95% CI: 0.36-0.97]) and those with low knowledge level (OR = 0.47 [95% CI: 0.29-0.74]). HCV diagnosis was reported by nine respondents (1.3%), of whom only four reported receiving treatment (44%). CONCLUSIONS: Our study indicates inadequate knowledge levels and relatively low testing rate. These findings underscore the need for national awareness campaigns and more effective strategies for HCV screening.

Satisfactory outcomes of post-operative subtalar extra-articular arthroereisis in juvenile flexible flat foot.

OBJECTIVES: To analyze the surgical outcomes of subtalar extra-articular arthroereisis and the patient/parent satisfaction regarding the foot's shape, foot pain, ability to walk, ability to jump, and shoe wear. METHODS: Our retrospective cross-sectional study was carried out through an online-based questionnaire to assess patient satisfaction postoperatively at 3 hospitals (King Khalid University Hospital, Sultan bin Abdulaziz Humanitarian City, and Dallah Hospital, Riyadh, Saudi Arabia) between the years 2014-2021. RESULTS: A total of 65 patients participated in our study. Approximately 86.1% of them had the operation bilaterally. The most important aspects where patients noticed the most improvement were the foot's shape (90.8%), pain (81.5%), and ability to walk (76.9%). CONCLUSION: Several studies have been carried out highlighting the surgical technique and complications of the procedure. However, a limited number of studies have been carried out to assess patient satisfaction with the procedure, especially in Saudi Arabia, as the procedure is considered relatively new in the region with insufficient data regarding it. Therefore, this study is considered one of the few articles regarding subtalar extra-articular arthroereisis in the region.

Medication Non-Adherence among Patients with Chronic Diseases in Makkah Region.

BACKGROUND: The Makkah region is the most populated region in Saudi Arabia. Studying medication adherence levels may help to improve general health outcomes and decrease overall health care expenditures. METHODS: We used the ARMS scale to assess medication adherence. Bivariable analysis of medication non-adherence was performed. Simple and multiple logistic regression models were built to identify factors associated with medication non-adherence. RESULTS: Participants from the Makkah region were more than two times more likely to be non-adherent to their medications compared to other regions (adjusted OR = 2.58, 95% CI: 1.49-4.46). Patients who dispensed their prescriptions at their own expense were two times more likely to be non-adherents (adjusted OR = 2.36, 95% CI: 1.11-4.98). Patients who had a monthly income ≤6000 SR were almost two times more likely to be non-adherents (unadjusted OR = 1.73, 95% CI: 1.05-2.84). CONCLUSION: Medication adherence is one of the most important factors to help managing the disease. We found that Makkah chronic patients are more likely to be non-adherent with their medications compared to other regions' patients. Moreover, we found that lower monthly incomes and paying for medications out-of-pocket were significant predictors of medication non-adherence.

Vitamin D serum level predicts stroke clinical severity, functional independence, and disability-A retrospective cohort study.

Background: Stroke is a leading cause of mortality and disability and one of the most common neurological conditions globally. Many studies focused on vitamin D as a stroke risk factor, but only a few focused on its serum level as a predictor of stroke initial clinical severity and recovery with inconsistent results. The purpose of this study was to assess the relationship between serum vitamin D levels and stroke clinical severity at admission and functional independence and disability at discharge in Saudi Arabia. Methodology: A retrospective cohort study of adult ischemic stroke patients who had their vitamin D tested and admitted within 7 days of exhibiting stroke symptoms at King Abdulaziz Medical City (KAMC) Jeddah, Saudi Arabia. Based on vitamin D level, the patients were categorized into normal [25(OH)D serum level ≥ 75 nmol/L], insufficient [25(OH)D serum level is 50-75 nmol/L], and deficient [25(OH)D serum level ≤ 50 nmol/L]. The primary outcome was to assess the vitamin D serum level of ischemic stroke patients' clinical severity at admission and functional independence at discharge. The National Institute of Health Stroke Scale (NIHSS) was used to assess the clinical severity, whereas the modified Rankin scale (mRS) was used to assess functional independence and disability. Results: The study included 294 stroke patients, out of 774, who were selected based on the inclusion and exclusion criteria. The mean age of the participants was 68.2 ± 13.4 years, and 49.3% were male. The patients' distribution among the three groups based on their vitamin D levels is: normal (n = 35, 11.9%), insufficient (n = 66, 22.5%), and deficient (n = 196, 65.6%). After adjusting for potential covariates, regression analysis found a significant inverse relationship of NIHSS based on 25(OH)D serum level (beta coefficient: -0.04, SE: 0.01, p = 0.003). Patients with deficient serum vitamin D level also had significantly higher odds of worse functional independence in mRS score [OR: 2.41, 95%CI: (1.13-5.16), p = 0.023] when compared to participants with normal vitamin D level. Conclusion: Low vitamin D levels were associated with higher severity of stroke at admission and poor functional independence and disability at discharge in patients with acute ischemic stroke. Further randomized clinical and interventional studies are required to confirm our findings.

Complete Laryngotracheal Separation Secondary to Blunt Trauma: A Case Report.

Complete laryngotracheal separation is a rare life-threatening trauma that may occur due to road traffic accidents. Unfortunately, this injury may be missed if emergency physicians were not aware of its possibility. We present a pediatric patient who had complete laryngotracheal separation and esophageal injury caused by strangulation with a headscarf while riding a four-wheeled motorcycle. The neck on external examination showed only a ligature mark without open wounds. The injury was identified while attempting tracheostomy as the patient had a decreased oxygen saturation and was aphonic. The patient underwent complete airway reconstruction and stenting as well as low tracheostomy with complete reconstruction and anastomosis of the esophagus. The patient was decannulated after a few weeks with the vocal cords in paramedian position and no aspiration. This case demonstrates that early prompt treatment can save the patient's life and result in good functional outcomes.

Perception of Threat and Psychological Impact of COVID-19 among Expatriates in Makkah Region, Saudi Arabia.

In the first few months of the pandemic, Makkah region reported the highest number of COVID-19 cases among all regions in Saudi Arabia. More than 80% of these reported cases were non-Saudi residents. In this study, we evaluated the perceived threat from and psychological impact of COVID-19 among non-Saudi residents of Makkah region. This was a cross-sectional analysis of data collected using a standardized self-report questionnaire. A total of 292 expatriates were included in the study, the majority of whom were non-Arabic speakers. The prevalence of self-reported depression was nearly 40%, anxiety was 32%, and stress was 43%. The findings indicated variability in the prevalence of psychological symptoms among expatriates from different ethnic backgrounds. Additionally, work environment and perceived threat were strong predictors of psychological disorders. This suggested that the perceived threat from and psychological burden of COVID-19 among non-Saudis in Makkah region is substantial. Future research should investigate the reasons behind these variations in the psychological impact of the pandemic among different ethnic groups.

Reporting Quality of Cost-Effectiveness Analyses Conducted in Saudi Arabia: A Systematic Review.

OBJECTIVES: Pharmacoeconomics and health economics in general is a new field that is still developing and emerging, not only in Saudi Arabia but all over the world. The objective of this study is to collect all published cost-effectiveness analysis (CEA) studies conducted based on Saudi settings and to evaluate their reporting quality. METHODS: We used PRISMA guidelines to search for all English-language CEAs conducted in Saudi Arabia in 3 databases: Medline, Embase, and Scopus. Keywords used in the search were: cost-effectiveness, cost-benefit, cost-utility, economic evaluation, Saudi Arabia. The data extracted were analyzed to assess reporting quality based on Consolidated Health Economic Evaluation Reporting Guidelines (CHEERS) and the second panel recommendations. RESULTS: The 3 databases yielded 859 articles after removing duplicates. Only 7 articles included as final results following PRISMA guidelines. These 7 studies were published between 2015 and 2020. The CEA studies varied in their reporting quality; however, there were common missing required items among all of them, such as justifying choosing of a specific model and time horizon and reporting the ethical implications of the studied interventions. CONCLUSION: Seven published CEA studies were conducted based on Saudi settings as revealed by this review. The included studies reported the more important aspects of CEA studies. However, there were missed reporting items based on the checklists we used to assess CEAs in this review. Although perfect and complete adherence to CHEERS or the second panel guidelines is a high standard, future CEAs should adhere to such standards. Transparency and good reporting are cornerstones in CEAs, and future CEAs should report their methods, findings, and results in a more transparent and efficient way.

Barriers to the Treatment of Hepatitis C among Predominantly African American Patients Seeking Care in an Urban Teaching Hospital in Washington, D.C.

BACKGROUND: In the United States, it is estimated that 2.4 million people are currently infected with the hepatitis C virus (HCV). In order to address HCV infection management in the U.S., several government entities collaborated to develop and release a multistep plan for the prevention, care, and treatment of viral hepatitis. Optimal health outcomes from the plan are contingent upon addressing each of the several steps in the HCV care cascade. Among the critical challenging steps is linkage to care and access to treatment. Of the nearly three million people in the U.S. infected with HCV, only 43% have been linked to care, 16% have received treatment, and 9% have had their infection resolved. OBJECTIVE: This retrospective study aims to identify predictors within the HCV treatment cascade that contribute to failures in care of HCV-infected patients in an urban hospital setting located in the District of Columbia. SETTING: The outpatient clinics of a tertiary-care urban teaching hospital. METHODS: A retrospective study was conducted using electronic medical records of persons 18 years and older who were HCV antibody positive and had at least one visit at any of the outpatient clinics from August 1, 2015 to August 1, 2016. Descriptive analysis of HCV positive persons was conducted, and predictors of HCV treatment were assessed. RESULTS: A total of 252 patients were included in the study. Overall, patients were predominantly male (63.1%), African American (97.6%), under the age of 65 (71.4%), covered by public insurance (89.3%), and were diagnosed with HCV after the year 2001 (53.2%). Additionally, majority of patients had not been treated for their HCV infection (58%). Multiple barriers resulted in HCV infected patients not obtaining access to treatment. Fibrosis stage (p < 0.001) and prior insurance denial (p < 0.05) were significant predictors of HCV treatment. Age, gender, insurance type, substance abuse, alcohol abuse, and year of HCV diagnosis were not associated with limited access of HCV treatment. CONCLUSION: HCV infections remain a major public health concern among patients in the District of Columbia. This study identified fibrosis stage and prior insurance denial as primary barriers to access of HCV treatment. While there are many points in the hepatitis cascade of care in which patients can lose access to or fail treatment completion, the primary point of intervention in our patient population appears to be during the initiation of treatment and insurance prior authorization process.

The Psychological Impact of COVID-19 on Healthcare Workers in Saudi Arabia: A Year Later Into the Pandemic.

Objective: The COVID-19 pandemic poses unprecedented challenges to healthcare workers worldwide. This study sought to estimate the prevalence of depression, anxiety, and stress among healthcare workers in Saudi Arabia, and to identify the factors associated with these psychological disorders. Methods: A cross-sectional questionnaire-based study was conducted from January 21 to March 2, 2021. Physicians, pharmacists, nurses, and other healthcare workers from different parts of Saudi Arabia were recruited through snowball sampling. Psychological outcomes were measured using the Depression, Anxiety, and Stress Scale (DASS-21). Pearson's chi-square test was used to explore the bivariate association between diverse characteristics and each outcome. Multiple logistic regression analyses were performed to identify factors associated with depression, anxiety, and stress. Results: A total of 501 healthcare workers completed the survey, of whom 60% were female and nearly half were pharmacists. The majority (76.25%) of respondents reported that a family member, friend, or colleague had contracted COVID-19, and more than one-third (36%) knew someone who died due to COVID-19. Overall, the estimated prevalence rates of depression, anxiety, and stress were 54.69, 60.88, and 41.92%, respectively. The multivariate analysis revealed that healthcare workers with chronic diseases, nurses, and healthcare workers from the southern region were more likely to suffer from depression and stress. Further, individuals with positive COVID-19 test results showed a greater proportion of depressive symptoms compared to others. In addition, knowing someone who died due to COVID-19 and having a chronic illness were predisposing factors for anxiety. Conclusion: After more than a year, the prevalence of depression, anxiety, and stress remains substantial among healthcare workers in Saudi Arabia. The findings can help guide efforts to mitigate the psychological impact of the pandemic.

Patterns of Hepatitis C-Related Inpatient Mortality in the United States in the Era of Direct-Acting Antivirals.

BACKGROUND & AIMS: Direct-acting antivirals (DAA) have revolutionized the management of hepatitis C virus (HCV) infection. Data on national inpatient mortality in this new era are scarce. This study aimed to evaluate inpatient mortality among HCV-related hospital stays in the United States (US) during the years DAA were available. METHODS: We conducted a cross-sectional analysis of the National Inpatient Sample (NIS) between 2012 and 2016. Using discharge weights, national estimates of HCV-related hospitalizations were calculated. Simple and multiple logistic regressions were performed to identify factors associated with inpatient mortality. RESULTS: A total of 67,630 hospitalizations from NIS were HCV-related, accounting for an estimated 338,150 hospitalizations during 2012 - 2016. These hospitalizations have estimated average annual total charges of $4.6 billion, adjusted to 2020 US dollars. The rate of inpatient mortality declined modestly from 5.25% in 2012 to 4.75% in 2016 (P=0.07). Over the 5-year study period, the proportion of in-hospital deaths increased for black patients, Medicaid beneficiaries, and patients with substance-related disorders. Controlling for known predictors, the odds of inpatient mortality were significantly greater among black patients compared to white patients (OR= 1.27 [95% CI=1.16 - 1.39]). CONCLUSIONS: The burden of HCV infection is substantial given the disease is now curable. Our findings indicate that major disparities in the HCV disease burden exist in the era of DAA.

Knowledge and attitude regarding child abuse among primary health care physician in Abha, Saudi Arabia, 2018.

BACKGROUNDS: Child abuse or child maltreatment is physical, sexual, or psychological maltreatment or neglect of a child or children, especially by a parent or other caregiver. Child abuse may include any act or failure to act by a parent or other caregiver that results in actual or potential harm to a child, and can occur in a child's home or in the organizations, schools, or communities the child interacts with. This study was conducted to assess the primary health care (PHC) centers' physicians' knowledge and attitude toward child abuse including its types, and child neglect with their behavior regarding reporting of abuse cases. METHODS: A cross-sectional study was conducted in Abha which is the capital of Aseer Province, including all PHC physicians (about 475) working in PHC centers. Data regarding physicians' demographic characteristics, perception, and awareness regarding child abuse and neglect were collected by self-administrative questionnaire in the PHC center during their time between patients' consultation. RESULTS: The study included 300 PHC physicians whose ages ranged from 25 to 50 years old with mean age of 28 years. About 65% of the physicians were males and 69% of them were married with about 73% having at least one child. Overall, 96.3% of the physicians recorded good awareness level regarding types of child abuse and 97.3% recorded good awareness level regarding child neglect patterns. Underreporting of child abuse cases was recorded by about 64% of physicians. CONCLUSION: Regarding child abuse and neglect, PHC physicians have good knowledge, optimal attitude, and positive perception. There was also the problem of underreporting of suspected child abuse cases among PHC physicians in Saudi Arabia, with many barriers to report, such as community traditions; unclear reporting strategy was identified.

Factors Associated with Prescribing Broad-Spectrum Antibiotics for Children with Upper Respiratory Tract Infections in Ambulatory Care Settings.

OBJECTIVES: Broad-spectrum antibiotics are frequently prescribed for children with upper respiratory tract infections (URI). Excessive use of broad-spectrum antibiotics leads to the emergence of resistant bacteria. This study aimed to identify factors associated with prescribing broad-spectrum antibiotics among children younger than 18 years presenting with URI in outpatient settings. METHODS: We conducted a cross-sectional analysis of the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey-Outpatient Departments (NHAMCS-OPD) between 2006 and 2010. Descriptive statistics of visits from children with URI were estimated. Simple and multiple logistic regression analyses were used to identify socio-demographic and clinical characteristics associated with broad-spectrum antibiotic prescribing. We also completed a stratified analysis by age (⩽2 vs >2). RESULTS: A total of 4013 outpatient visits for children with URI from both NAMCS and NHAMCS-0PD data were examined. Broad-spectrum antibiotics were prescribed in 39% of the visits, accounting for an estimated 6.8 million visits annually. Multivariable analysis showed that visits in the South region (odds ratio [OR] = 2.38; 95% confidence interval [CI]: 1.38-4.10) compared with the West region and visits with diagnoses of acute sinusitis (OR = 2.77; 95% CI: 1.65-4.63) and acute otitis media (OR = 1.90; 95% CI: 1.32-2.74) compared with those with acute pharyngitis were associated with greater odds of broad-spectrum antibiotic prescribing. CONCLUSIONS: The prescribing of broad-spectrum antibiotics is common for children with URI in ambulatory care settings. Diagnosis and management of URI remain a critical area for awareness campaigns promoting judicious use of antibiotics.